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Background <p>Aquablation is a semi-automated, ejaculation-sparing surgical option for treatment of benign prostatic hyperplasia (BPH). While previous studies have demonstrated that approximately 50 cases are required to achieve surgical competence in prostate laser enucleation, objective evaluations of Aquablation learning curve remain limited. The aim of this study was to assess Aquablation learning curve using cumulative sum (CUSUM) method, based on operative parameters and postoperative outcomes.</p> Methods <p>We retrospectively analyzed data from 80 patients who underwent Aquablation by a single surgeon with prior experience in prostate resection and enucleation (01/2024 – 07/2025). Patient demographics, including prostate volume (PV) and comorbidities, were recorded. Operative parameters were collected. Patient evaluations were conducted at baseline, 3, 6&#xa0;months postoperatively, including uroflowmetry and assessment using the International Prostate Symptom Score (IPSS). Ejaculation preservation was assessed. Trifecta was defined as preserved ejaculation, IPSS &lt; 8, and maximum urinary flow rate (Qmax) &gt; 15&#xa0;mL/s at 6&#xa0;months. Descriptive statistics, linear regression analyses, and CUSUM method were applied.</p> Results <p>Median (interquartile range [IQR]) prostate volume and baseline IPSS-total score were 60 (45–78) mL and 21 (14–27). Median total operative time was 39 (31–47) minutes. Postoperative complications occurred in 18 patients (22.5%). Median IPSS-total score and Qmax improved significantly at 3- and 6-month follow-up visits (p &lt; 0.01). Antegrade ejaculation was preserved in 81.2% of patients at 6-month follow-up. Trifecta at 6&#xa0;months was achieved in 49 patients (61.2%). CUSUM analysis demonstrated that learning curve for setup and ablation tissue time reached plateau after 14 cases, while coagulation time stabilized after 21 procedures. CUSUM charts for trifecta achievement revealed an initial learning phase requiring 18 cases to achieve stable performance, subsequently maintained.</p> Conclusion <p>Aquablation is a reproducible, ejaculation-sparing surgical option for BPH, with procedural efficiency and stable functional outcomes achieved after approximately 12–21 cases. Aquablation offers a faster acquisition of technical proficiency due to its high degree of automation and standardized planning, leading to a rapid integration into clinical practice.</p>

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The learning curve of waterjet ablation of the prostate: a cumulative sum analysis of surgical and functional outcomes

  • 期刊论文

  • 发表日期：

    2026年7月25日

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  • Federica Passarelli,
  • Giorgio Graps,
  • Ludovico Maria Basadonna,
  • Fabrizio Longo,
  • Elisa De Lorenzis,
  • Giancarlo Albo,
  • Emanuele Montanari,
  • Luca Boeri

摘要

Background

Aquablation is a semi-automated, ejaculation-sparing surgical option for treatment of benign prostatic hyperplasia (BPH). While previous studies have demonstrated that approximately 50 cases are required to achieve surgical competence in prostate laser enucleation, objective evaluations of Aquablation learning curve remain limited. The aim of this study was to assess Aquablation learning curve using cumulative sum (CUSUM) method, based on operative parameters and postoperative outcomes.

Methods

We retrospectively analyzed data from 80 patients who underwent Aquablation by a single surgeon with prior experience in prostate resection and enucleation (01/2024 – 07/2025). Patient demographics, including prostate volume (PV) and comorbidities, were recorded. Operative parameters were collected. Patient evaluations were conducted at baseline, 3, 6 months postoperatively, including uroflowmetry and assessment using the International Prostate Symptom Score (IPSS). Ejaculation preservation was assessed. Trifecta was defined as preserved ejaculation, IPSS < 8, and maximum urinary flow rate (Qmax) > 15 mL/s at 6 months. Descriptive statistics, linear regression analyses, and CUSUM method were applied.

Results

Median (interquartile range [IQR]) prostate volume and baseline IPSS-total score were 60 (45–78) mL and 21 (14–27). Median total operative time was 39 (31–47) minutes. Postoperative complications occurred in 18 patients (22.5%). Median IPSS-total score and Qmax improved significantly at 3- and 6-month follow-up visits (p < 0.01). Antegrade ejaculation was preserved in 81.2% of patients at 6-month follow-up. Trifecta at 6 months was achieved in 49 patients (61.2%). CUSUM analysis demonstrated that learning curve for setup and ablation tissue time reached plateau after 14 cases, while coagulation time stabilized after 21 procedures. CUSUM charts for trifecta achievement revealed an initial learning phase requiring 18 cases to achieve stable performance, subsequently maintained.

Conclusion

Aquablation is a reproducible, ejaculation-sparing surgical option for BPH, with procedural efficiency and stable functional outcomes achieved after approximately 12–21 cases. Aquablation offers a faster acquisition of technical proficiency due to its high degree of automation and standardized planning, leading to a rapid integration into clinical practice.