UP-61 Routine Use of Focal Bladder Neck Cautery in 1116 consecutive Aquablation controls Postoperative Bleeding
Thursday June 27, 2019 from

Dean S. Elterman, Canada

Assistant Professor

Division of Urology

University Health Network, University of Toronto


Routine use of focal bladder neck cautery in 1116 consecutive aquablation controls postoperative bleeding

Dean S. Elterman1, Burhard Ubrig2.

1University Health Network, Toronto, ON, Canada; 2Witten/Herdecke University, Augusta-Kranken-Anstalt, Bochum, Germany

Introduction: To determine if focal bladder neck cautery effectively prevents blood transfusions across various prostate volumes following prostate tissue resection for benign prostatic hyperplasia using Aquablation.

Methods: Consecutive patients between late 2019 and August 2020 undergoing Aquablation followed by focal bladder neck cautery from 11 countries from Asia, Europe, and North America were evaluated for transfusions.

Results: 1,116 Aquablation cases were performed using focal bladder neck cautery with a mean prostate size of 81 cc (range 20 to 300cc). The average time spent after removing the handpiece to inserting the urinary catheter was 18 minutes. This segment of the procedure includes flushing, transitioning to the resectoscope, and cauterizing at the bladder neck. Postoperative bleeding requiring transfusion occurred in seven cases (0.6%, 95% CI 0.3%-1.3%). This result compares favorably (p<.0001) to the previously published hemostasis aggregate transfusion rate of 31/801 (3.9%) using methods performed in the years 2014 to 2019, Figure 1.

Conclusions: Routine use of additional focal bladder neck cautery subsequent to aquablation will bring down the risk of postoperative bleeding to a level known from TURP or HoLEP while preserving the main strategic goals of aquablation:  reliable desobstruction of the prostatic urethra, high safety profile for protection of the urinary sphincter, high efficacy in preserving antegrade ejaculation, minimizing and standardizing the ablative procedure.

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