To evaluate whether prostate size influences perioperative, urinary, and sexual outcomes following Aquablation for benign prostatic hyperplasia (BPH), by comparing men with prostates < 80 cc and ≥ 80 cc treated within a prospective real-world cohort.
This prospective, single-center cohort study included consecutive men undergoing Aquablation between 2023 and 2025. Patients were stratified by prostate volume (< 80 cc vs. ≥80 cc). Baseline characteristics, perioperative parameters, and functional outcomes were assessed using validated instruments, including IPSS, IPSS-QoL, irritative subscore, ICIQ-SF, IIEF-EF, MSHQ-EjD, and MSHQ-bother, at baseline and at 3, 6, 12, and 24 months. Complications were graded according to the Clavien-Dindo classification.
A total of 628 men were included (324 with prostates < 80 cc and 304 with prostates ≥ 80 cc). Men with larger prostates had higher rates of preoperative catheter dependence (34% vs. 18.2%, p < 0.001). Operative time (40.6 ± 14.1 vs. 36.2 ± 12.6 min, p = 0.001) and hospitalization duration (2.5 ± 1.5 vs. 2.09 ± 0.8 days, p < 0.001) were longer in the ≥ 80 cc group. Both cohorts demonstrated marked and durable improvement in urinary symptoms, with mean IPSS improving from 24.5 to 6.7 in the < 80 cc group and from 24.9 to 6.0 in the ≥ 80 cc group at 24 months. Irritative symptom scores improved from 10.3 to 3.5 and from 10.5 to 2.1, respectively (p < 0.001). Sexual outcomes remained stable across prostate sizes, with preserved erectile function and low ejaculatory bother scores. High-grade complications (Clavien-Dindo III-IV) were uncommon and comparable between groups (2.7% vs. 4.3%), while reoperation rates remained low (3.1% vs. 3.9%).
Aquablation provides durable symptom relief with preservation of sexual function across a broad range of prostate volumes, supporting its role as a size-independent surgical treatment option for BPH.
World journal of urology. 2026 Jul 30*** epublish ***
Dolev Perez, Ariel Mamber, Michael Pasherstnik, Dmitry Koulikov, Ala Eddin Natsheh, Ofer Z Shenfeld, Ilan Z Kafka, Boris Chertin
The Department of Urology, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University, P.O.B. 3235, 91031, Jerusalem, Israel. ., The Department of Urology, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University, P.O.B. 3235, 91031, Jerusalem, Israel.