Aquablation versus HoLEP in patients with benign prostatic hyperplasia: a comparative prospective non-randomized study.

PURPOSE: The question of best surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) remains controversial. We compared the outcomes of aquablation and holmium laser enucleation of the prostate ("HoLEP") in a prospective cohort. METHODS: Patients with BPH underwent aquablation or HoLEP according to their preference between June 2020 and April 2022. Prostate volume ("PV"), laboratory results, postvoid residual volume, uroflowmetry, IPSS, ICIQ-SF, MSHQ-EjD, EES and IIEF were evaluated preoperatively and at three, six and 12 months postoperatively. We also analyzed perioperative characteristics and complications via the Clavien Dindo ("CD") classification. RESULTS: We included 40 patients, 16 of whom underwent aquablation and 24 HoLEP. Mean age was 67 years (SD 7.4). Baseline characteristics were balanced across groups, except the HoLEP patients' larger PV. IPSS fell from 20.3 (SD 7.1) at baseline to 6.3 (SD 4.2) at 12 months (p < 0.001) without differences between aquablation and HoLEP. HoLEP was associated with shorter operation time (59.5 (SD 18.6) vs. 87.2 (SD 14.8) minutes, p < 0.001) and led to better PV reduction over all timepoints. At three months, aquablation's results were better regarding ejaculatory (p = 0.02, MSHQ-EjD) and continence function (p < 0.001, ICIQ-SF). Beyond three months, erectile, ejaculatory, continence function and LUTS reduction did not differ significantly between aquablation and HoLEP. CD ≥ grade 3b complications were noted in six patients in aquablation group while only one in HoLEP group (p = < 0.01). CONCLUSIONS: While aquablation revealed temporary benefits regarding ejaculation and continence at three months, HoLEP was superior concerning operation time, the safety profile and volumetric results.

Retrospective Evaluation of the Clinical Values of Minimally Invasive Marsupialization of Symptomatic Giant Renal Cysts.

Background: To evaluate the indication and benefit of minimally invasive laparoscopic marsupialization (MIS) of symptomatic giant renal cysts. Materials and Methods: Sixty-four consecutive patients who underwent MIS for large renal cysts (Bosniak I; 4 × 5-16 × 12 cm) by one surgeon were included in the study. Presenting symptoms were renal pain (100%), associated with hypertension (28%), renal dysfunction (4.7%), hematuria (4.7%), ureteropelvic junction obstruction (UPJO) (7.8%), ipsilateral urolithiasis (4.7%), polycystic kidney (6.3%), adrenal cyst (1.6%), and retroperitoneal cysts (1.6%). Seven patients with peripelvic cysts and previous retroperitoneal operations were treated by a laparoscopic approach; all other patients underwent retroperitoneoscopic marsupialization. Single-port retroperitoneoscopy was performed in 4 patients. Follow-up included clinical examination, abdominal ultrasound, and computed tomography scan. Postoperative radiologic success was defined as a minimum of 50% in size reduction and no recurrence. Results: Mean patients' age was 46 (21-65) years. All procedures were successfully completed without conversion or revision. Mean operative time was 55 (40-85) minutes with a mean hospital stay of 3 days. All patients underwent uneventful postoperative recovery. Observed minor complications (transitory fever/pain) were found in 4 patients during the first postoperative month. Median follow-up was 12 months (10 months-2 years). About 98.5% of patients reported of no relevant postoperative pain. A relief from UPJO and hematuria was achieved in 100% of patients. Ten patients with known hypertensive disease (55.6%) had a significant reduction of mean blood pressure resulting in a reduction of antihypertensive medication. Ureterorenoscopic stone extractions were performed successfully afterward. No cyst recurrences were detected during the follow-up period. Conclusion: Treatment indications for symptomatic renal cysts could include not only symptoms but also associated diseases like UPJO and hypertension. Retroperitoneoscopic MIS may be curative for these cyst-associated pathologies. The feasibility, safety and efficacy of these techniques could be demonstrated.