Rectal perforation after aquablation of the prostate: lessons learned the hard way

Gross, Andreas J.; Lipp, Michael; Baumbach, R; Becker, Benedikt; Vogt, Katharina; Rosenbaum, Clemens M.; Netsch, Christopher

doi:10.1007/s00345-021-03660-2

Cited by 10 publications

(4 citation statements)

References 8 publications

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“…Documentation of intraoperative complications and of surgical step-specific complications is crucial to increase awareness and gain an understanding of the etiology and the actions necessary to avoid and deal with these events [41,[53][54][55][56][57][58]. With the advent of minimally invasive surgery [59], particularly robotic surgery [60], routine collection of intraoperative videos allows surgeons to accurately inspect the actions responsible for iAEs to analyze surgical stepspecific complications in more depth, which can aid surgeons in appropriate operative planning, highlight precautionary measures to prevent iAEs, and facilitate the learning process for addressing emergency situations [41,[53][54][55]. For this reason, the panel agreed that iAEs and their management should be reported with specification of the surgical step that was associated with or affected by each iAE (criteria 9 and 11).…”

Section: Discussionmentioning

confidence: 99%

“…Early detection and quick resolution of iAEs are the basic principles to decrease late morbidity and secondary mortality. Delay in iAE recognition may complicate the treatment of intraoperative complications and, in the worst-case scenario, end in life-threatening or fatal events [54,68]. Thus, the panel recommends reporting the timing of iAEs (criterion 10).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project: Development of Criteria for Reporting Adverse Events During Surgical Procedures and Evaluating Their Impact on the Postoperative Course

Cacciamani

Sholklapper

Dell’Oglio

et al. 2022

European Urology Focus

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project: Development of Criteria for Reporting Adverse Events During Surgical Procedures and Evaluating Their Impact on the Postoperative Course

Cacciamani

Sholklapper

Dell’Oglio

et al. 2022

European Urology Focus

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“…TUR-P is associated with a significant range of complications [12,13], i.e., urethral or bladder neck strictures. However, aquablation is also known to cause relevant complications, for example postoperative bleeding complications or-rarelyrectal perforation [14]. Postoperative bleeding was particularly evident in conjunction with very large prostates [15] or when cauterization was deliberately omitted [16].…”

Section: Introductionmentioning

confidence: 99%

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

Michaelis,

Träger,

Astheimer

et al. 2024

World J Urol

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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.

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“…Gross et al und Kaplan-Marans et al berichteten beispielsweise über 2 bzw. 4 Rektumperforationen nach Aquaablation[80,81]. Datenanalysen der FDA-Datenbank (MAUDE-Datenbank) berichten über erhebliche Komplikationen nach MIST-Therapien: Bluttransfusionen (n = 21), Beckenhämatome (n = 13), Embolisationen (n = 1), Drainageneinlagen (n = 1), Laparotomien (n = 2), Blasenperforationen (n = 2), Orchiektomie (n = 1), Urosepsis, (n = 7), nekrotisierende Faziitis (n = 1) nach PUL.…”

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Minimal Invasive Surgical Techniques (MIST): wie relevant ist der ganze Mist?

Netsch,

Gross,

Herrmann

et al. 2024

Aktuelle Urol

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Zusammenfassung Aufgrund der steigenden Lebenserwartung und der wachsenden Nachfrage nach BPH-Behandlungen wurden innovative Technologien entwickelt, die eine zügige Erholung, Symptomlinderung, geringe Komplikationsraten sowie die Durchführung des Eingriffs ambulant und teilweise unter lokaler Betäubung ermöglichen. Das Ziel dieser Übersichtsarbeit ist es, die Ergebnisse der funktionellen Miktionsparameter und der sexuellen Funktion neu entwickelter minimalinvasiver chirurgischer Therapien (MIST) zur Behandlung der BPH zu beschreiben. Diese werden in primär ablative (Aquaablation [Aquabeam]), nicht-ablative (Prostata-Harnröhren-Lifting-Verfahren [PUL, Urolift], temporär implantierbare Körbchen [iTind]), und sekundär ablative Verfahren (konvektive Wasserdampfablation, Rezum, Prostataarterienembolisation [PAE]) unterschieden. Alle MIST-Technologien haben die medizinische Versorgung der BPH mit der Erhaltung der Ejakulation vorangetrieben. Langzeitdaten, die sich speziell mit Reinterventionsraten und den Erhalt der funktionellen Miktionsparameter beschäftigen, sind derzeit jedoch noch eine Seltenheit. Trotz vielversprechender Daten aus den Zulassungsstudien sowie aus randomisierten Studien, zeigen alle MIST-Therapien auch schwerwiegende Komplikationen. Patienten, die für eine solche Methode vorstellig werden, müssen über die Unterlegenheit im Gegensatz zu den etablierten transurethralen Verfahren wie die TUR-P und die Enukleation umfassend aufgeklärt werden.

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Rectal perforation after aquablation of the prostate: lessons learned the hard way

Cited by 10 publications

References 8 publications

The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project: Development of Criteria for Reporting Adverse Events During Surgical Procedures and Evaluating Their Impact on the Postoperative Course

The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project: Development of Criteria for Reporting Adverse Events During Surgical Procedures and Evaluating Their Impact on the Postoperative Course

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

Minimal Invasive Surgical Techniques (MIST): wie relevant ist der ganze Mist?

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