First-in-US Pilot Study of Aquablation in Ambulatory Surgery Centers: Clinical Outcomes and Economic Feasibility

Abstract

Objective

To evaluate the clinical outcomes and economic feasibility of Aquablation therapy for benign prostatic hyperplasia (BPH) performed in a U.S.-based ambulatory surgery center (ASC) setting.

Methods

This single-center cohort study included 101 men with moderate to severe lower urinary tract symptoms (LUTS) secondary to BPH who underwent Aquablation at a physician-owned ASC with no overnight admission capabilities. Patients were followed for 3 months postoperatively. Clinical outcomes including symptom scores, uroflow parameters, sexual health metrics, and complications were assessed. Additionally, reimbursement data from 169 cases were analyzed to evaluate economic impact and contribution margins relative to traditional resective BPH procedures.

Results

All 101 patients were successfully discharged the same day, with a mean recovery room stay of 1.5 hours and no transfers or 30-day readmissions. IPSS scores improved from a baseline mean of 22.0 to 9.2 at 3 months. Qmax increased from 10.6 to 18.3 mL/sec, and post-void residual decreased from 161.0 to 40.1 mL. The overall Clavien-Dindo grade ≥III complication rate was 1%. Economic analysis showed ASC Aquablation had significantly higher contribution margins compared to TURP, Greenlight, and HoLEP, and saved the healthcare system an average of $1,800 per case compared to hospital-based Aquablation.

Conclusions

Aquablation can be safely and effectively performed in an ASC setting with clinical outcomes that mirror the pivotal trials and a favorable economic profile. These findings support the feasibility of outpatient Aquablation as a cost-conscious, high-value treatment option for BPH.

Marhamati, S., Kangotra, I., Perez, D., Rayan, D., Umanzor, L., Lavoie, J., Gandhi, N., Desai, P., Lim, K., Zorn, K., Klein, J., & Singh, I. (2025). First-in-US pilot study of Aquablation in ambulatory surgery centers: Clinical outcomes and economic feasibility. Urology. Advance online publication. https://doi.org/10.1016/j.urology.2025.09