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COMPARISON OF FOCAL BLADDER NECK VERSUS WHOLE-PROSTATE CAUTERIZATION OUTCOMES FOLLOWING AQUABLATION: A SINGLE INSTITUTION STUDY
Abstract   Peer reviewed

COMPARISON OF FOCAL BLADDER NECK VERSUS WHOLE-PROSTATE CAUTERIZATION OUTCOMES FOLLOWING AQUABLATION: A SINGLE INSTITUTION STUDY

Kristofer Muzzi, Sami Musallam, Brenda Leanne Yujun Hug, David Matatov and Matthew Sterling
Neurourology and urodynamics, v 45 Suppl 1, pp S124-S124
01 Feb 2026
DOI: https://doi.org/10.1002/nau.70235
PMID: 41762117

Abstract

Introduction: Aquablation is a minimally invasive, robotically guided water‐jet procedure for the treatment of benign prostatic hyperplasia (BPH). Although tissue resection is automated, hemostasis remains surgeon‐dependent and varies in both extent and technique. Given this variability, we compared operative characteristics and early postoperative outcomes between focal bladder neck and whole‐prostate cauterization following Aquablation. Methods: We performed a retrospective review of all Aquablation cases performed by five surgeons between November 2023 and June 2025 at a single institution. Patients were categorized by cauterization technique: focal bladder neck or whole‐prostate. Collected data included prostate volume, voiding parameters including maximum flow rate (Qmax) and post‐ void residual (PVR), as well as intraoperative characteristics and postoperative outcomes at 6 months. Continuous and categorical variables were analyzed using nonparametric and chi‐square‐based tests, with correlations assessed via Spearman analysis. Statistical significance was defined as p < 0.05. Results: A total of 201 patients were analyzed (median age 69 years, range 63–75). Median prostate volume was 56 mL (43–72), with a median case time of 54 min (45–68). Operative time increased with more extensive cauterization (r = 0.41, p < 0.001), while improvements in Qmax and reductions in PVR were comparable between groups (p > 0.05). The overall complication rate was 14.7%, including urinary retention (6.6%), bleeding requiring transfusion (4.6%), and urethral stricture (3.0%). Stricture formation correlated with longer case time (p = 0.04) and greater degree of cauterization (p = 0.02). No significant differences were observed between focal bladder neck and whole‐prostate cauterization groups in postoperative retention or transfusion rates (p > 0.05). Conclusions: Whole‐prostate cauterization after Aquablation was associated with longer operative times and a higher risk of postoperative urethral stricture compared to focal bladder neck cauterization. Despite these differences, bleeding and retention rates were similar between groups. These findings suggest that broader cauterization may increase urethral morbidity without clear hemostatic benefit. Further study is needed to define the optimal cauterization strategy that balances bleeding control while minimizing complications.

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