545 Abolishing the Learning Curve for Treating Large Benign Prostatic Obstruction: Robotic Water Jet Ablation (Aquablation™)

Abstract

Abstract Aim Aquablation™ is an ultrasound-guided robotic treatment for lower urinary tract symptoms due to benign prostatic obstruction (BPO), enabling management of large prostates (>80cc), however the learning curve in this cohort remains understudied. To evaluate this, we compared outcomes from our first 20 cases to our last 20 cases, in men with large prostates (>80cc). Method We analysed data from a prospectively collected database of all men treated with Aquablation™ in our centre since July 2022. Data on patient demographics, prostate volume, operative time, peri-operative complications, and 3-month objective and subjective outcomes, were collected. Intra and post-operative outcomes in the first 20 cases were compared to the last 20 cases. Results A total of 114 men (mean age 67, range 47–87) underwent Aquablation™. Outcomes of the first 20 cases (performed by three different surgeons) were compared to the last 20 cases (performed by an experienced surgeon who had performed >50 cases). Between the first 20 and last 20 cases, mean prostate volumes were similar (108 cc vs 126 cc), with most men treated for bothersome lower urinary tract symptoms (12 vs 14). No clinically significant differences were observed in operative time (65 min vs 66 min), successful trial without catheter rates, or postoperative complication rates, including haemoglobin drop at day 1 post-op, blood transfusion, and return to theatre for diathermy. Conclusions Aquablation™ is a safe and reproducible treatment for large BPO, offering predictable outcomes with minimal learning curve, enabling urologists to manage complex cases effectively.