Abstract No. 101 Staged Prostate Artery Embolization Reduces the Risk of Post-Aquablation Hemorrhage

Aquablation (AA) is an emerging, minimally invasive treatment for benign prostatic hyperplasia. Compared to transurethral resection of the prostate (TURP), the gold-standard for BPH, AA has the potential for shorter procedure times and fewer complications1,2. While promising, AA is associated with an increased risk of post-procedural bleeding, especially for larger prostate sizes ( >80 cc).2 Prostate artery embolization is being used increasingly as both a primary and adjunct intervention for BPH. PAE's efficacy in reducing arterial prostate blood flow makes it a feasible candidate to reduce post-AA bleeding. This retrospective study compared the rate of post-procedural bleeding complications and treatment efficacy in patients with staged PAE prior to AA to AA alone. A single-institution institutional review board–approved retrospective analysis of all patients undergoing AA alone and staged PAE prior to AA between November 2020 to May 2022 were included. All patients underwent preoperative imaging and urologic evaluation. Pre and post procedural hemoglobin, platelets, bleeding complications, AUA and QOL scores were recorded. Patients were assessed for anticoagulation status and history of bleeding. A p-value of 0.05 was chosen as the threshold for statistical significance. A total of 27 patients underwent staged PAE prior to AA with a mean age of 73.1 years, pre-op AUA of 19.2, pre-op hemoglobin 14.1 g/dL, and pre-op platelets of 230 × 109 L. A total of 28 patients underwent AA alone with a mean age of 70 years, pre-op AUA of 17, pre-op hemoglobin 14.4 g/dL, and pre-op platelets of 231 × 109 L. Patients treated with combined PAE and AA had larger prostates (188 mL vs. 95 mL, p < 0.0001). Combined PAE and AA had a lower bleeding complication rate than AA alone (0.0% vs. 7.1%, p = 0.19). Although not statistically significant, these results are promising given larger prostates inherently yield higher risks of bleeding, and despite the increased risk, no bleeding complications were observed in the combined PAE and AA treatment arm. Lastly, combined treatment of PAE and AA showed a larger reduction in AUA/IPSS scores compared to AA alone (13.2 vs 11.2, p = 0.43), although this was not statistically significant. This developmental study shows staged PAE with AA reduces the rate of bleeding complications, especially in larger prostate volumes (>80 mL). Further, staged PAE with AA could provide a synergistic effect with improved treatment outcomes compared to either therapy alone when treating larger prostates.