Aquablation for Benign Prostatic Hyperplasia: A Prospective Study with Comparative Analysis of Transurethral Resection of the Prostate and Holmium Laser Enucleation

Abstract

Introduction:

Benign prostatic hyperplasia is a leading cause of lower urinary tract symptoms in aging men. When medical therapy fails, surgery is indicated. This study evaluates the safety and efficacy of Aquablation compared with transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP) in patients with bladder outlet obstruction.

Methods and Materials:

A prospective analysis of 318 Aquablation patients (2023–2025) was conducted and compared with 83 TURP and 83 HoLEP patients from a retrospective database. Functional outcomes were assessed using International Prostate Symptom Score (IPSS), ICIQ-UI, EF-IIEF, and MSHQ-EJD SF. Complications were graded using the Clavien-Dindo classification. Follow-ups were performed at 3, 6, and 12 months.

Results:

Aquablation patients had larger prostates than TURP (94 versus 54.7 cc; P < .0001) but smaller than HoLEP (105 cc; P = .002) patients. More Aquablation patients had indwelling catheters and were on anticoagulants (P < .0001). IPSS improvement was the greatest in Aquablation (18.9 points) versus TURP (13.8) and HoLEP (14.7; P = .000). Erectile function was preserved in Aquablation (P = .859), with significantly better ejaculatory function (82.8% preserved) than TURP (36%) and HoLEP (18%). Furthermore, Clavien-Dindo grade 1–2 complications were higher in Aquablation, but serious events (CD 3–4) were comparable. Complication rates declined significantly after the first 30 Aquablation cases.

Conclusion:

Aquablation is an effective surgical option for medium to large prostates, offering superior symptom relief and preservation of sexual function. Although its learning curve is shorter than HoLEP’s, proper training is essential to minimize early complications.