Outcomes of Aquablation in BPH with bladder stones: Analysis of the ICARUS database

Abstract Objective The purpose of this study is investigate the clinical outcomes of men with benign prostatic hyperplasia (BPH) and bladder stones treated concomitantly with Aquablation and bladder stone removal in an international, multi‐institutional cohort. Patients and Methods We performed a retrospective analysis of men who underwent Aquablation between 2018 and 2024. Patients were divided into two cohorts: men with bladder stones and those without. Outcomes assessed included baseline demographics and variables (medication use, prostate volume, prior BPH surgery), operative characteristics (OR time, transfusion requirement, complications), and functional outcomes were measured by the International Prostate Symptom Score (IPSS), peak urinary flow rate ( Q max ) and PVR at regular intervals over 24 months. Results A total of 1885 men were analysed, including 60 men with bladder stones and 1825 without. Patients with bladder stones had higher rates of prior BPH surgery (15% vs. 5.5%, p = 0.015) and pre‐operative urinary retention (28.3% vs. 14.8%, p = 0.004) as well as larger prostate volumes (98.6 ml vs. 77 ml, p < 0.0001). Total operative time was longer in the bladder stone group (76.5 mins vs. 55.0 mins, p < 0.001), but there were no significant differences in Aquablation time or bleeding complications including transfusions. There was also no difference in improvements in IPSS, Q max and PVR post‐operatively. Conclusion This study demonstrates that Aquablation is safe and effective in the management of BPH regardless of concomitant bladder stone treatment.