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Zorn KC, Chakraborty A, Chughtai B, Mehan R, Elterman D, Nguyen DD, Bouhadana D, Glaser AP, Marhamati S, Barber N, Helfand BT. Safety and Efficacy of Same Day Discharge for Men Undergoing Contemporary Robotic-Assisted Aquablation Prostate Surgery in an Ambulatory Surgery Center Setting - First Global Experience. Urology 2024:S0090-4295(24)00658-7. [PMID: 39159759 DOI: 10.1016/j.urology.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVE To investigate the feasibility, safety and efficacy of same day discharge (SDD) after Aquablation specifically in an ambulatory surgery center (ASC). METHODS A prospective cohort of men with significant BPH underwent Aquablation at a single ASC. Comprehensive preoperative assessments were conducted, including uroflowmetry, IPSS, and PVR. Aquablation was performed as morning cases by a single experienced surgeon. Following the procedure, men were assessed for immediate postoperative outcomes, including pain levels, hematuria, and voiding efficiency. Patients meeting discharge criteria were allowed to return home on the same calendar day. RESULTS A total of 60 consecutive men with a mean prostate size of 115ml underwent Aquablation, 59 (98%) of whom were discharged the dame day. No transfusions or return to the OR occurred. The procedure demonstrated a significant improvement in urinary flow rates and a substantial reduction in IPSS scores at the 1-month post-operative period. Pain scores were found to be minimal, and the incidence of postoperative complications, including hematuria and urinary retention was low and comparable to previously published outcomes. Despite more meticulous focal cautery, no differences in erectile, ejaculatory or adverse outcomes were observed. CONCLUSIONS Aquablation for BPH at an ASC appears to be a safe and effective approach. Morning procedures and attentive cautery and streamlined patient pathways seem essential for SDD. Despite electrosurgical hemostasis, ejaculatory, sexual and post-operatively pain were not compromised.
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Affiliation(s)
- Kevin C Zorn
- BPHCanada Prostate Center, Mont-Royal Surgical Center, Montreal, QC, Canada.
| | | | - Bilal Chughtai
- Division of Urology, Northwell Health, Plainview, New York
| | | | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David-Dan Nguyen
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Bouhadana
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Alexander P Glaser
- Endeavor Health (Formerly NorthShore University HealthSystem), Department of Surgery, Division of Urology, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Department of Surgery, Division of Urology, Chicago, IL, USA
| | | | | | - Brian T Helfand
- Endeavor Health (Formerly NorthShore University HealthSystem), Department of Surgery, Division of Urology, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Department of Surgery, Division of Urology, Chicago, IL, USA
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Nguyen DD, Li T, Ferreira R, Baker Berjaoui M, Nguyen ALV, Chughtai B, Zorn KC, Bhojani N, Elterman D. Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation. Prostate Cancer Prostatic Dis 2024; 27:22-28. [PMID: 37081044 DOI: 10.1038/s41391-023-00669-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is one of the most common diseases affecting men and can present with bothersome lower urinary tract symptoms (LUTS). Historically, transurethral resection of the prostate (TURP) has been considered the gold standard in the treatment of LUTS due to BPH. However, TURP and other traditional options for the surgical management of LUTS secondary to BPH are associated with high rates of sexual dysfunction. In the past decade, several novel technologies, including Aquablation therapy, convective water vapor therapy (Rezum), and transperineal prostate laser ablation (TPLA), have demonstrated promising evidence to be safe and effective while preserving sexual function. METHODS In this review, we discuss three ablative minimally invasive surgeries: Aquablation, Rezum, and TPLA. We review their techniques, safety, as well as perioperative and functional outcomes. We go into further detail regarding sexual function after these ablative minimally invasive surgical therapies. RESULTS Aquablation is a surgeon-guided, robot-executed, heat-free ablative waterjet procedure with sustained functional outcomes at 5 years while having no effect on sexual activity. Rezum is an innovative office-based, minimally invasive surgical option for BPH that delivers convective water vapor energy into prostate adenoma to ablate obstructing tissue. Rezum leads to significant improvements in Qmax, IPSS while preserving sexual function. TPLA is another office-based technology which uses a diode laser source to produce thermoablation. It leads to improvement in Qmax, IPSS, and QoL while preserving ejaculatory function. CONCLUSIONS Overall, ablative minimally invasive surgical therapies have demonstrated excellent safety and efficacy profiles while preserving sexual function. These modalities should be discussed with patients to ensure informed and shared decision-making. Ablative minimally invasive surgical therapies may be particularly interesting to patients who value the preservation of their sexual function.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tiange Li
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Roseanne Ferreira
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Anna-Lisa V Nguyen
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Probst P, Desai M. Expectations Facing Reality: Complication Management after Aquablation Treatment for Lower Urinary Tract Symptoms. Eur Urol Focus 2022; 8:1733-1735. [PMID: 35589510 DOI: 10.1016/j.euf.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/26/2022] [Indexed: 01/25/2023]
Abstract
Aquablation is a modality recently introduced for surgical treatment of men with symptomatic benign prostatic hyperplasia. Large multi-institutional studies have shown a relatively low rate of high-grade (Clavien-Dindo grade ≥3) complications. Postoperative bleeding primarily depends on prostate volume and approached 8.3% in the initial cumulative experience, for which catheter traction was the predominant hemostatic technique. A systematic and reproducible technique for cautery loop hemostasis has reduced the hemorrhage rate to 1.4%. PATIENT SUMMARY: Aquablation is a surgical treatment option for enlarged prostate glands that are causing urinary problems. This technique uses a water jet to remove prostate tissue and has a relatively low rate of serious complications.
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Affiliation(s)
- Patrick Probst
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Mihir Desai
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Deyirmendjian C, Elterman D, Chughtai B, Zorn KC, Bhojani N. Surgical treatment options for benign prostatic obstruction: beyond prostate volume. Curr Opin Urol 2022; 32:102-108. [PMID: 34669611 DOI: 10.1097/mou.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Many surgical treatment options are available for patients who present with benign prostatic obstruction (BPO). This article reviews the current treatment options available and distinguishes them based on five clinical considerations: antithrombotic therapy, sexual function preservation, ambulatory procedures, anesthesia-related risks and duration of catheterization. RECENT FINDINGS A comprehensive review of the literature was performed on 10 BPO procedures. Laser enucleation of the prostate (LEP), bipolar plasma transurethral vaporization of the prostate and photoselective vaporization (PVP) of the prostate reduces the risk of bleeding, which is recommended for anticoagulated men. Ejaculatory function is more likely to be preserved following transurethral incision of the prostate, Rezūm, Aquablation, UroLift and iTind. Same-day discharge is possible for LEP, PVP and prostatic arterial embolization (PAE). For patients with high anesthesia-related risks, procedures compatible with local anesthesia (UroLift, Rezūm, iTind and PAE) should be favored. Catheterization duration is shorter with UroLift, PVP and LEP. SUMMARY BPO treatment options are growing rapidly. The optimal procedure for a given patient is based on factors such as associated risks, recovery and expected outcomes. Besides prostate volume, the clinical considerations in the present article can help elucidate the best surgical BPO treatment option for each patient based on their values, preferences, and risk tolerance.
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Affiliation(s)
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
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Elterman D, Gao B, Lu S, Bhojani N, Zorn KC, Chughtai B. New Technologies for Treatment of Benign Prostatic Hyperplasia. Urol Clin North Am 2021; 49:11-22. [PMID: 34776045 DOI: 10.1016/j.ucl.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BPH is a common disease in aging men which impacts quality of life. With advancing age expectation coupled with the rising demand for BPH therapy, new technologies have been developed that target rapid recovery and symptom relief, low complication rates, and the ability to perform the procedure in an outpatient setting with local anesthesia. MIST technologies have fostered BPH medical care with ejaculation preservation. Techniques and outcomes for BPH technologies including Aquablation, Rezūm, UroLift, iTind, Optilume BPH, XFLO, Zenflow, and Butterfly are reviewed and evaluated. Given the novelty of these technologies, long-term data are required to assess safety and efficacy.
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Affiliation(s)
- Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, 399 Bathurst Street, MP-8-317, Toronto, Ontario M5T 2S8, Canada.
| | - Bruce Gao
- Division of Urology, Department of Surgery, University of Toronto, 399 Bathurst Street, MP-8-317, Toronto, Ontario M5T 2S8, Canada
| | - Steven Lu
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada
| | - Naeem Bhojani
- Department of Surgery, University of Montreal (CHUM), 2900 Edouard Montpetit Boulevard, Montreal, Quebec H3T 1J4, Canada
| | - Kevin C Zorn
- Department of Surgery, University of Montreal (CHUM), 2900 Edouard Montpetit Boulevard, Montreal, Quebec H3T 1J4, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, 25 East 68th Street, Starr 9, New York, NY 10065, USA
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