V08-03 PROSTATE AQUABLATION: HOW TO DO IT (A STEP-BY-STEP VISUAL GUIDE)

Abstract

INTRODUCTION AND OBJECTIVE: Aquablation is a novel and minimally invasive alternative to transurethral resection of the prostate for treating lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). It's an image-guided robot-assisted waterjet ablation of the prostate that combines an integrated cystoscope with intra-operative transrectal ultrasound (TRUS) images. The aim of this video is to share our experience and offer a step-by-step guide to perform the Aquablation technique. METHODS: The surgery was performed with the AquaBeam® system (PROCEPT BioRobotics, Redwood Shores, CA, USA) under spinal anesthesia. A biplanar TRUS probe was used. A 24-F handpiece was inserted transurethrally. Both the handpiece and the TRUS were fixed to articulating arms attached to the operating table. Real-time ultrasound imaging outlines the surgeon-planned prostatic fossa and a robotically guided handpiece containing a side-firing nozzle shoots a high-velocity water-jet from bladder neck to verumontanum in a single pass (in most cases). This precise and fast (+/- 5 min) ablation is able to preserve anterograde ejaculation by sparing the ejaculatory function anatomical landmarks and protecting the urinary sphincter. Hemostasis was achieved by a Foley catheter balloon tamponade. There are various methods of post-Aquablation hemostasis, however the most adequate is still evolving. Case Report: A 56-year-old patient with LUTS secondary to BPH with a prostate volume of 88 mL, a PSA of 2.8 ng/ mL, a Qmax of 7.5 mL/sec and IPSS of 29. RESULTS: Total operative time was 19 minutes from setup through Aquablation. The bladder catheter was removed on postoperative day 2, at the same time the patient was discharged without complication. The 3-month postoperative assessment showed a significant improvement in the voiding function from baseline, a PSA of 1.5 ng/mL, a Qmax of 23mL/sec and IPSS of 6. Anterograde ejaculation was preserved and there was no incontinence or erectile dysfunction. This video demonstrates how to perform Aquablation, a procedure that has been proven to be safe, efficient and easy to learn, regardless of prostate size (up to 150mL). CONCLUSIONS: This video serves as a step-by-step visual guide to perform Aquablation. It has been demonstrated previously in the literature that the combination of robotics and image guidance increases reliability and significantly reduces the operative/resection time and improves anterograde ejaculation preservation. These promising results warrant further studies to assess long-term outcomes.