Aquablation as salvage therapy for benign prostatic hyperplasia: an international multicentre study

OBJECTIVE: Our objective was to evaluate the safety and effectiveness of Aquablation® as a salvage therapy in patients who underwent prior intervention for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We retrospectively analysed 1887 consecutive men from the International Collaborative Aquablation Research Urology Society database between 2018 and 2024 who underwent Aquablation at one of four international centres. The cohort was divided into two groups based on the presence or absence of previous BPH intervention. Baseline characteristics, clinical and functional outcomes, and complication rates were compared between the two groups using analysis of variance and Kruskal-Wallis tests. Finally, exploratory sub-analyses were performed in the salvage therapy group based on the type of prior BPH intervention. RESULTS: Among the study population of 1887 men, 109 (5.8%) patients had undergone prior BPH intervention, and the remaining 1778 (94.2%) patients served as a control cohort. Prostate volumes were similar between both groups (82.3 vs 78.0 mL; P = 0.18). There were no significant differences in perioperative complications, 30-day readmission rates, surgical retreatment rates, or sexual function outcome scores (all P > 0.05). There were also similar improvements in maximum urinary flow rates, post-void residuals, International Prostate Symptom Scores, and quality of life scores (all P > 0.05). When comparing outcomes based on the type of prior BPH intervention, there were no differences in terms of operative time, prostate volumes, presence of median lobe, or complication rates. CONCLUSION: We observed no statistically significant differences in safety or effectiveness for Aquablation as a salvage therapy for recurrent lower urinary tract symptoms after BPH intervention. Aquablation should be offered to men for whom prior procedures have failed and who want to preserve continence and sexual function.