Safety and efficacy of aquablation in men 80 years or older: an analysis of the international collaborative aquablation research urology society (ICARUS) real-world database.

PURPOSE: Aquablation is under-researched, especially in the elderly. As older patients face higher risks of surgical complications, this study aims to evaluate the safety and efficacy of Aquablation in octogenarians. METHODS: This retrospective, multi-center study includes 2136 patients who underwent Aquablation between 2018 and 2024. Patients were divided into two cohorts, ≥ 80 and < 80 years of age, consisting of 206 and 1930 men, respectively. Data included baseline characteristics, operative characteristics, and post-operative functional outcomes. Peri-operative events were compared. RESULTS: Men ≥ 80 had higher rates of anxiety/depression (32% vs 16%, p = 0.0032), 5α-reductase inhibitor use (35% vs 19%, p = 0.0009), and anticoagulation (56% vs 24%, p < 0.0001). Mean prostate volume was similar between groups, but men ≥ 80 were less likely to have a median lobe (52% vs 63%, p = 0.003). Both groups showed similar improvements in peak urinary flow rate, post-void residual, International Prostate Symptom Score and quality of life. Men ≥ 80 had higher rates of take-back for cystoscopy/clot evacuation (4.4% vs 1.9%, p = 0.034), transfusions (2.9% vs 0.5%, p = 0.003) and 30-day readmissions (4.2% vs 0.7%, p = 0.002). Age and urinary retention were associated with a composite bleeding outcome. There were no changes in erectile function and no differences in retrograde ejaculation between groups. CONCLUSION: This study is the first to assess Aquablation's safety and efficacy across all ages. Aquablation offers similar voiding improvements in men aged ≥ 80 as in younger men, with slightly higher perioperative risks. Thus, Aquablation should be considered for well-selected, elderly patients with significant BPH who wish to preserve sexual function. However, as fewer than half of patients had follow-up beyond 8 months, these findings primarily reflect short-term outcomes.