Aquablation Compared with Simple Prostatectomy for Prostate Volumes >80 Grams.

Introduction and Objectives: Aquablation (Aqua) is a novel technique for treating benign prostatic hyperplasia and lower urinary tract symptoms. This study compares Aqua to simple prostatectomy (SP), analyzing functional urinary outcomes, adverse events (AE), and retreatment rates. Methods: A single-institution retrospective chart review was conducted for men undergoing open/robotic SP or Aqua from 2017 to 2023 for prostates >80 mL. Data collected included blood transfusions, AE, retreatment rates, postoperative medication use, and International Prostate Symptom Score (IPSS) with quality-of-life (QOL) indicator. To address differences in baseline characteristics, including prostate size, we applied inverse probability of treatment weighting (IPTW). Statistical analyses were performed using R 4.4.0. Results are presented as IPTW-adjusted comparing SP to Aqua using Fischer's exact test and analysis of variance reported as beta (B) for continuous variables and odds ratios (OR) for categorical variables with 95% confidence intervals (CI). Results: In total, 172 patients were studied: 111 Aqua and 61 SP. Groups were well-matched for body mass index (Aqua 28.77 vs SP 28). Aqua patients were older (73.04 vs 68.89), had smaller prostates (135.46 vs 186.53 mL), and lower preoperative urinary retention (21.8% vs 47.5%). Baseline characteristics between groups were adjusted using IPTW. SP outperformed Aqua in 1-year IPSS scores (B = -3.4, CI: -5.7, -1.1, p = 0.005), whereas QOL was comparable (B = -0.46, CI: -1.3, 0.33, p = 0.2). SP patients continued alpha-blockers less often postoperatively (B = -0.27, CI: -0.39, -0.41, p = 0.001). SP showed higher blood transfusion rates (OR = 4.22, CI: 1.64, 13.2, p = 0.006), longer hospital stays (B = 1.7, CI: 1.0, 2.4, p < 0.001), and longer operating times (B = 119, CI: 101, 135, p < 0.001). SP had lower retreatment rates (OR = 0.46, CI: 0.23, 0.87, p = 0.019). AE were not significantly different (p = 0.8). Conclusions: Aqua outperformed SP for blood transfusions, hospital stay, and operative time. SP outperformed Aqua for retreatment rates, IPSS scores at 1-year follow-up, and reliance on alpha-blockers.