Introduction: Aquablation of the prostate is a novel robotic-assisted procedure that uses a powerful ultrasound and cystoscopic guided water jet for the treatment of benign prostatic hyperplasia (BPH).

Aims: To assess the efficiency and safety of the Aquablation procedure for the treatment of BPH among patients treated in our institution.

Methods: A retrospective analysis of the first 50 cases was performed in our institution between 10/2022 and 05/2023. We gathered demographic information, surgical and post-surgical course, and office follow-up 1,3 and 6 months after surgery, including the evaluation of urination parameters and sexual function.

Results: Fifty patients were included in the study, with a median age of 69 years and median prostate volume of 74 ml (range 31-138 ml). Thirteen patients carried a urethral catheter or used clean intermittent catheterization due to urinary retention. The median duration of surgery was 51 minutes (intra-quadrate range 38-57). In all patients, the surgery was completed as planned with no intra-operative complications. The average drop in hemoglobin level after surgery was 1.2 mg/dL only. Two patients (4%) were given a blood transfusion due to a symptomatic drop in hemoglobin levels. None of the patients were taken to the operating room (OR) for an urgent hemostasis surgery. The IPSS (international prostate symptoms score) improved by an average of 13 points, with quality-of-life questions improving by 2.25 points. The functional outcomes were stable over 6 months after surgery. All patients with pre-operative urinary retention eventually had their catheter removed (one patient required another procedure - transurethral resection of the prostate (TURP)). Significant urinary incontinence was not reported by any of the 50 patients.

Conclusions: Aquablation of the prostate is a novel surgical technique, which is accurate, efficient, with a low rate of complication and side effects, and is performed over a short duration of time. The procedure may be performed on prostates up to 150 ml in volume. The rate of complication and auxiliary procedures is very low in the short term, and the functional outcomes are very good in the short term. This procedure has a place in the first line of modern BPH surgeries.