Informative value of histological assessment of tissue acquired during aquablation of the prostate
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ORIGINAL ARTICLE
Informative value of histological assessment of tissue acquired during aquablation of the prostate Gautier Müllhaupt1 · Annette Enzler‑Tschudy2 · Katarina Horg2 · Lukas Bubendorf3 · Manolis Pratsinis1 · Hans‑Peter Schmid1 · Dominik Abt1 Received: 16 June 2020 / Accepted: 24 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To determine the histological validity of the tissue acquired during aquablation of the prostate. Patients and methods Prostatic tissue of 12 patients that consecutively underwent aquablation for benign prostatic enlargement was systematically examined. Histological examination was performed by two experienced uropathologists using a digital slide scanner and slide viewer software (Pannoramic 250 and Case Viewer 2.3, 3D Histech, Hungary). The surface areas of the assessable glands were examined and set in relation to the total surface area of the material available for histology and to the patient’s total prostate volume. Examinations were performed analogously in ten consecutive patients undergoing transurethral resection of the prostate (TURP) to facilitate interpretation of the results. Data were analyzed using descriptive statistics. Results A median of 4.06% (range 1.43–7.5%) of the preoperative total prostate volume (median 64.5 ml (range 40–80 ml)) was obtained for histological examination by aquablation. Due to severe mechanical destruction and fragmentation, only a proportion of 0.43% (0.06–1.79%) of this tissue represented histologically assessable glands. Therefore, roughly 0.017% of the total prostatic volume was available for a reliable histological examination. In comparison, 32.5% (6.67–37.5%) of the total prostate volume was removed by TURP and 22.86% (7.45–40.57%) of this tissue represented informative prostatic glands, corresponding to 7.43% of the total prostate volume. Conclusion Histological significance of the tissue obtained by aquablation of the prostate is very limited. Costs and effort of the histological examination must, therefore, be weighed critically against the limited informative value. Keywords Aquablation · AquaBeam · Histology · Prostate · Benign prostatic hyperplasia · prostate tissue
Introduction
Gautier Müllhaupt and Annette Enzler-Tschudy contributed equally to this study. * Gautier Müllhaupt [email protected] 1
Department of Urology, St. Gallen Cantonal Hospital, Klinik für Urologie, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
2
Department of Pathology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
3
Institute of Medical Genetics and Pathology, University Hospital of Basel, Basel, Switzerland
Aquablation is a robotically guided, water jet-based prostate resection under transrectal sonographic control [1, 2] that emerged during the last years and is now recommended by international evidence-based guidelines [3, 4]. The system includes a peristaltic active-aspiration pump to maintain constant intra-vesical pressure and acquires tissue for histological
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