Presented by: Anindyo Chakraborty BSc.
Faculty of Medicine and Health Sciences, McGill University

Introduction

In this study, men undergoing Aquablation robotic prostate surgery with and without perioperative antithrombotic medications were examined for bleeding and other adverse events.

Materials

The study included 116 men with moderate-to-severe lower urinary tract symptoms who were part of the WATER prospective trial (NCT02505919) undergoing Aquablation therapy. Patients were assigned to one of two groups based on their antithrombotic use. Antithrombotic medications included antiplatelets (low dose aspirin and high dose aspirin/antiplatelets) and anticoagulation (warfarin). Intraoperative hemostasis was achieved via no-cautery balloon tamponde or cautery. Primary endpoints were immediate post-operative heamturia rates and changes in hemoglobin. Secondary endpoints were 90-day bleeding complications and rates of non-bleeding post-operative adverse events.

Results

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Forty-one men taking regular antithombotic medications in both the perioperative and post operative period were compared to 75 men with no use of antithrombotic medications. The rates of alpha-blocker or 5-alpha reductase inhibitor medications were comparable between both groups. There were no significant differences in perioperative hemoglobin levels. Post-operative hemoglobin dropped by among the antithrombotic gorup and in the antithrombotic-naïve group (p = 0.896). Four (9.8%) men in the antithrombotic group and 4 (5.3%) men in the antithrombotic-naïve group encountered a Clavien-Dindo Grade 1 complication in the 3-month postoperative period (p = 0.451). Eight (19.5%) men in the antithrombotic group experienced a Clavien-Dindo Grade 2 complication, none of which was associated with bleeding, whereas that number was 11 (14.7%) for the antithrombotic-naïve group (p = 0.601). Four (9.8%) men in the antithrombotic group and 4 (5.3%) men in the antithrombotic-naïve group had de-novo ejaculatory dysfunction (p = 0.451). No de novo erectile dysfunction was seen in either group. A single patient (2.4%) in the antithrombotic group required a blood transfusion whereas none did in the antithrombotic-naïve group (p = 0.353). 

Conclusion

Aquablation shares similar post-operative bleeding outcomes and other adverse rates for men with BPH who are on antithrombotic therapy to those without any antithrombotic medications. 

Funding

The original trial from which the data is derived was funded by PROCEPT BioRobotics. However, no funding was attributed for the purposes of this study.

Lead Authors

Iman Sadri, MD
Department of Urology, McGill University

Co-Authors

David-Dan Nguyen, MD
Division of Urology, University Health Network, University of Toronto

Adel Arezki, MD
Department of Urology, McGill University,

Kussil Oumedjbeur, MD
Division of Experimental Surgery, McGill University

Naeem Bhojani, MD
Division of Urology, Centre Hospitalier de L'Université de Montréal

Dean Elterman, MD
Division of Urology, University Health Network, University of Toronto

Bilal Chugtai, MD
Department of Urology, Weill Cornell Medical College–New York Presbyterian Hospital

Peter Gilling, MD
Department of Urology, Tauranga Hospital

Mihir Desai, MD
Catherine and Joseph Aresty Department of Urology, Keck School of Medicine

Leo Doumanian, MD
Institute of Urology, University of Southern California

Alexis Te, MD
Department of Urology, Weill Cornell Medical College–New York Presbyterian Hospital

Gopal Baldini, MD
Department of Urology, Wake Forest University

Claus Roehrborn, MD
Urology, The University of Texas Southwestern Medical Center

Kevin Zorn, MD
Division of Urology, Centre Hospitalier de L'Université de Montréal