Husam Al Maliki
Introduction
Surgical management of benign prostatic hyperplasia (BPH) can negatively affect urinary continence and sexual function, key determinants of post-operative quality of life. We compared patient-reported urinary continence and sexual outcomes following Aquablation and Holmium Enucleation of the Prostate (HoLEP) in single-centre cohort.
Methods
This retrospective single-centre study included men undergoing Aquablation or HoLEP for BPH between January 2023 and June 2025. Patients were contacted by telephone and completed validated post-operative questionnaires assessing urinary incontinence (ICIQ-UI Short Form), erectile function (SHIM), and ejaculatory function (MSHQ-EJD-SF). Baseline demographics and clinical variables were recorded and compared between groups.
Results
A total of 284 procedures were identified (118 Aquablation,166 HoLEP), with completed questionnaires from 66 Aquablation and 99 HoLEP patients. Median follow-up was 20 months (IQR 10-28). Baseline characteristics, including age, BMI, ASA score, IPSS, and Qmax, were comparable. Mean prostate size for Aquablation and HoLEP was 61cc (±31.5) and 97cc (±70.3) respectively. Aquablation was associated with significantly better urinary continence (mean ICIQ-UI 1.79 vs 3.73, p=0.007) and superior ejaculatory preservation (mean MSHQ-EJD-SF 6.03 vs 3.64, p<0.001). A negative impact on sexual function was reported by 17.7% of Aquablation patients compared with 55.7% following HoLEP (OR 5.82, 95% CI 2.71-12.51, p<0.0001). Erectile function was similar between the two groups (mean SHIM 13.18 vs 15.48, p=0.085).
Conclusions
Aquablation demonstrates significant advantages over HoLEP in urinary continence and ejaculatory outcomes without compromising erectile function. Our data supports Aquablation as a quality-of-life focused surgical option for appropriately selected men with BPH and should inform shared decision-making.
Authors
Husam Al Maliki, Urology department, Norfolk and Norwich University Hospitals, Norwich, United Kingdom & University of East Anglia, Norwich, United Kingdom
Simon Mcgurk, Shiv Sarna, Shaun James, Sachinka Ranasinghe, Johann Boaz, Mark Rochester, Urology department, Norfolk and Norwich University Hospitals, Norwich, United Kingdom