Impact of Median Lobe Presence on Clinical Outcomes Following Aquablation: an analysis of the International Collaborative Aquablation Research Urology Society (ICARUS) database

Impact of Median Lobe Presence on Clinical Outcomes Following Aquablation: an analysis of the International Collaborative Aquablation Research Urology Society (ICARUS) database | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Median Lobe Presence on Clinical Outcomes Following Aquablation: an analysis of the International Collaborative Aquablation Research Urology Society (ICARUS) database Ilan Ohana, David Bouhadana, Adel Arezki, Nick Lee, Anindyo Chakraborty, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7521461/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract INTRODUCTION AND OBJECTIVE: While the efficacy of Aquablation is established for varying prostate sizes, specific outcomes in patients with a median lobe have not been well studied. We evaluated the differences in perioperative and functional outcomes in patients undergoing Aquablation with and without a median lobe. METHODS: We performed an analysis of the International Collaborative Aquablation Research Urology Society (ICARUS) database, a multicentric international database. Patients were grouped based on the presence or absence of a median lobe. Operative characteristics (operative time, adverse events) as well as functional outcomes up to 24 months postoperatively including post-void residual (PVR) volume, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and the Sexual Health Inventory for Men (SHIM) questionnaires were assessed. RESULTS: A total of 1,999 men were included: 755 (38%) patients did not have a median lobe while 1,244 patients (62%) had a median lobe. Median (IQR) prostate volumes were 76 (54-106) mL and 80 (60-110) mL for each group, respectively (p=0.009). Baseline medications, including α-blockers and 5α-reductase inhibitors (5ARIs), were similar between groups. Total operative time (49 vs. 58 min, p<0.0001) and Aquablation time (6.3 vs. 7.3 min, p<0.0001) were slightly longer for those with a median lobe. Postoperative outcomes, including improvements in IPSS, IPSS-QoL, Qmax, and PVR were similar between groups. Rates of retrograde ejaculation were slightly higher in the median lobe cohort (11.2% vs 8.1%; p=0.0002), but there were no differences in postoperative SHIM scores. Adverse events including blood transfusions did not significantly differ between groups. CONCLUSIONS: The presence of a median lobe does not have a significant impact on the outcomes of Aquablation in a real-world setting. Using a large multicentric international database, this study demonstrates that Aquablation provides effective symptom relief and safety for both groups. Benign Prostatic Hyperplasia BPH Aquablation Median Lobe Urology Figures Figure 1 Figure 2 INTRODUCTION Aquablation is an innovative surgical treatment for benign prostatic hyperplasia (BPH) that combines real-time ultrasound guidance with robotic high-velocity saline jets to resect prostate tissue. Lower urinary tract symptoms (LUTS) secondary to BPH include a range of storage and voiding symptoms that significantly impact patients’ quality of life 1-3 . Management options vary widely, from lifestyle modifications and pharmacotherapy to procedural interventions, with transurethral resection of the prostate (TURP) widely considered the gold standard surgical procedure [1,4,5]. Minimally invasive procedures such as UroLift and Rezum can preserve ejaculatory function, but on average do not achieve the same degree of LUTS improvement as resective procedures such as TURP [6,7]. Aquablation has gained popularity for its ability to preserve sexual function while successfully improving LUTS to a degree similar to or better than TURP [2,8,9]. A median lobe, or intravesical prostatic protrusion (IPP), is an extension of the prostate’s transition zone into the bladder and contributes to more severe obstructive urinary symptoms. This obstruction often occurs due to a “ball-valve” effect, where the protruding median lobe obstructs urine flow, increasing bladder outlet obstruction and inhibiting the funnel effect of the bladder neck during urination [10]. Median lobe enlargement is prevalent and presents unique challenges in BPH management, affecting 30% of a cohort of men aged 40–79 with an IPP of 1–9 mm and 10% with an IPP ≥ 10 mm [11]. Traditional pharmacologic therapies may be less effective in patients with significant median lobe enlargement, leading to poorer outcomes compared to those without such anatomical variations. For instance, high IPP grades are associated with a higher risk of treatment resistance, increased risk of urinary tract infections, acute urinary retention, or the need for prostatic surgery [12]. This shows the importance of considering median lobe presence in treatment planning. Currently, limited data are available on the perioperative and long-term functional outcomes of Aquablation specifically in patients with median lobe enlargement. Aquablation has demonstrated consistent efficacy and safety compared to TURP across different prostate sizes, primarily in the WATER and WATER II pivotal trials [9,13,14]. However, these studies did not stratify outcomes based on detailed intraprostatic anatomy, such as median lobe presence. A key advantage of Aquablation is its precision in preserving critical anatomical structures, which helps maintain ejaculatory function. Careful contour planning, as emphasized by Nguyen et al. (2021), may improve postoperative ejaculation function by avoiding excessive resection near the verumontanum or ejaculatory ducts [15]. Given its ability to precisely and selectively resect tissue, Aquablation may offer superior outcomes in median lobe cases by effectively relieving obstruction while minimizing damage to surrounding structures. While existing research supports Aquablation’s safety and efficacy, the impact of the median lobe on perioperative outcomes and postoperative recovery remains underexplored. Given its anatomical challenges, we hypothesize that the presence of a median lobe may influence surgical outcomes, including operative time, complication rates, and functional outcomes such as symptom relief and postoperative recovery. By analyzing real-world data, this study aims to clarify these effects, providing insights into the overall effectiveness and safety of Aquablation therapy for patients with a median lobe, and its role as a patient-centered treatment for BPH. METHODS This retrospective, multicenter study utilized data from the International Collaborative Aquablation Research Urology Society (ICARUS) database, a comprehensive multicenter IRB-approved international registry of men undergoing Aquablation from 2019-2023 (EH20-122). Aquablation procedures were performed using two passes and focal bladder neck cautery [16]. Median lobes were identified on cystoscopy and real-time ultrasound imaging during Aquablation and contoured for resection with the high-velocity waterjet using the Aquablation system. Preoperative data collection encompassed patient demographics and medication use, including alpha-blockers, 5-alpha-reductase inhibitors, daily phosphodiesterase type 5 inhibitors, and anticoagulants. Laboratory values such as serum Prostate Specific Antigen (PSA) and Prostate Health Index (PHI) were recorded, along with prostate volume measurements and any history of prior surgical interventions for BPH. Baseline clinical parameters included maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), and patient-reported outcomes including the International Prostate Symptom Score (IPSS), IPSS quality of life (QoL) domain, and Sexual Health Inventory for Men (SHIM). Because the Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD) was not consistently administered across the ICARUS database, ejaculatory function was instead documented categorically at each site as one of the following: normal antegrade ejaculation, antegrade ejaculation with reduced or diminished volume, or retrograde ejaculation. Patients were divided into two groups based on the intra-operative presence or absence of a median lobe, as determined by the surgeon. The primary endpoints for the study included the IPSS and IPSS-QoL questionnaires assess at regular intervals (1-3, 4-8, 9-12 and 13-24 months) postoperatively. Secondary evaluations included PSA levels, PHI, PVR, Qmax, and SHIM. Retrograde ejaculation rates were also documented as part of the postoperative follow-up. Operative characteristics such as Aquablation and total operative time, blood transfusion rates, surgical complications as classified on the Clavien-Dindo scale, and 30-day readmission rates, were also recorded. Baseline characteristics and outcome measures were summarized using descriptive statistics. Continuous variables were expressed as means ± standard deviations or medians with interquartile ranges as appropriate and compared using ANOVA for normally distributed data or the Kruskal-Wallis test for non-normal distributions. Categorical variables were reported as frequencies and percentages and analyzed using the Chi-square test or Fisher’s exact test when appropriate. Statistical significance was set at p<0.05 for all analyses. Statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC) and R version 4.3.2. RESULTS Among the 1,999 patients, 62% (n=1244) had a median lobe and 38% (n=755) did not. The median age at time of surgery was slightly lower in the median lobe group (68 years vs. 70 years; p<0.0001). The median prostate volume was larger in the median lobe group with a median size of 80mL (IQR 60-110) compared to 76mL (54-106) in the group without a median lobe (p=0.009). Men with a median lobe were less likely to have undergone prior BPH surgery (4% vs 9%; p=0.001. Baseline PVR was slightly higher in the median lobe group (115mL vs. 101mL; p=0.0393), but baseline Qmax was similar between groups (8.2mL/sec vs 8.1mL/sec; p=0.91). Additional baseline characteristics are listed in Table 1. Total operative times were significantly longer in the median lobe group, with a median total operative time of 58 minutes compared to 49 minutes in the group without median lobes (p<0.0001). Similarly, Aquablation time was 7 minutes in the median lobe group compared to 6 minutes in the group without median lobes (p<0.0001; Table 2 ). There was no difference in bleeding complication rates based on the presence of a median lobe. The rate of takebacks for cystoscopy or clot evacuation was 2.18% in the median lobe group and 1.99% in the group without a median lobe (p=0.77). Blood transfusion rates were 0.73% and 0.93%, in both groups respectively (p=0.63). There was also no statistically significant difference in rates of 30-days readmissions between the groups, 0.71% in the median lobe group compared to 1.65% in the group without a median lobe (p=0.14). Both groups had similar rates of Clavien-Dindo complications, 12.6% in the median lobe group compared to 9.56% in the group without (p=0.07). Both groups demonstrated substantial post-operative functional improvements at 1-3 months follow up ( Table 3) . PVR decreased similarly across both groups, with a median reduction of 149mL in the median lobe group and 145mL in the group without a median lobe (p=0.75; Figure 1A ). Postoperative SHIM scores were also similar in both groups. Qmax increased by a mean of 12 mL/s in both groups (p=0.96; Figure 1B ). Improvements in IPSS and IPSS-QoL were similar throughout follow-up regardless of the presence of a median lobe ( Figure 2 ). Rates of retrograde ejaculation were higher in the median lobe group (11.2% vs. 8.1%; p=0.0002). Postoperative reductions in PSA levels were similar, with median PSA decrease of 2.88 ng/mL in the median lobe group compared to 2.69 ng/mL in the group without a median lobe (p=0.65). There was a larger reduction in PHI for men with a median lobe compared to men without a median lobe (6.93 vs. 2.38; p=0.0111). DISCUSSION This represents the largest real-world study to date examining Aquablation and the influence of a median lobe. Our findings indicate that despite the anatomical challenges associated with the presence of a median lobe, functional improvements including reduction of IPSS, IPSS-QoL and PVR as well as increases in Qmax are comparable over the long term between patients undergoing Aquablation with a median lobe to those without one. However, the presence of a median lobe was associated with a slightly longer operative time (9 minutes) and a slightly higher rate of retrograde ejaculation (11% vs 8%). While statistically significant, these small differences may not be clinically significant and warrant replication before broad conclusions should be made. Overall, our results reinforce the versatility of Aquablation and its ability to accommodate anatomical variations without compromising efficacy or safety. The slightly longer operative times in patients with a median lobe were expected due to the additional anatomical challenge posed by the median lobe, but this did not negatively affect functional outcomes. Previous studies have shown that Aquablation requires less operative time than GreenLight Photovaporization (PVP), Thulium Laser Enucleation of the Prostate (ThuLEP), GreenLight Laser Enucleation of the Prostate (GreenLEP), and Holmium Laser Enucleation of the prostate (HoLEP) [17]. Aquablation demonstrated the shortest operative time across all prostate volumes, with a slope of 0.16 min/g compared to 0.32 min/g for GreenLEP, 0.28 min/g for HoLEP, 0.32 min/g for ThuLEP, and 0.63 min/g for PVP. In comparison, a review article by Tokarski et al. (2021) demonstrated that Aquablation offers operative times similar to TURP and shorter than HoLEP, while maintaining comparable efficacy and safety outcomes [18]. Additionally, the WATER trial showed no significant difference in overall mean operative time between Aquablation and TURP, with a significantly shorter resection time using Aquablation (4 vs. 27 min, p<0.0001) [13]. Overall, even with the slight increase in procedure time for median lobe anatomy, Aquablation remains a time efficient treatment modality. Our study did show slightly higher rates of retrograde ejaculation in patients with a median lobe (11.2% vs. 8.1%, p=0.0002). This aligns with findings from the literature indicating that anatomical factors, such as bladder neck involvement, may contribute to ejaculatory dysfunction. Previous studies have shown that preservation of the bladder neck during TURP significantly reduces retrograde ejaculation rates compared to standard TURP, likely due to the protection of smooth muscle fibers that facilitate bladder neck closure [19]. While Aquablation preserves the bladder neck, we could hypothesize that more aggressive treatment of IPP and the bladder neck may be associated with slightly higher risks of ejaculatory dysfunction. However, the overall rate of ejaculatory dysfunction is low in both groups, and is comparable to rates reported in the literature after Aquablation [14,20,21]. Although the presence of a median lobe may add complexity to the procedure, our real-world study demonstrates that voiding outcomes including IPSS, IPSS-QoL, PVR, and Qmax were unaffected. This supports Aquablation’s applicability in anatomically complex cases, further distinguishing it from traditional methods like TURP, which are associated with high rates of ejaculatory dysfunction and complications [22-24]. These findings align with previous studies, including the WATER trials, which demonstrated sustained improvements in LUTS with IPSS, IPSS-QoL, PVR, and Qmax, along with minimal impact on ejaculatory function across prostate sizes, even over extended follow-up periods [9,13,14]. Real-world data and a French clinical registry further emphasized the effectiveness of Aquablation for treating BPH, complementing the findings of both WATER trials [21,25]. Moreover, our results are compatible with findings from other modalities. For example, Nguyen et al. analyzed the impact of a median lobe on GreenLight PVP outcomes using a large international database [26]. While they found a slightly longer operative time for median lobe cases, functional outcomes such as IPSS and Qmax were comparable between groups. However, unlike GreenLight PVP, Aquablation provides a robotically controlled, automated approach, potentially reducing operator variability and enhancing precision. Overall, our findings indicate no major functional differences between both groups, further supporting the broad applicability of Aquablation in patients with diverse anatomical variations. In our study, 30-day readmission rates, Clavien–Dindo complications and blood transfusion rates were comparable between patients with and without a median lobe, indicating that the anatomical complexity did not increase perioperative risk. Specifically, 30-day readmission rates were 0.71% for patients with a median lobe and 1.65% for those without one (p=0.14). By comparison, a registry of 3,059 men undergoing elective TURP reported a 7.4% 30-day readmission rate [27]. Among laser-based treatments, 24% of GreenLight PVP and 26.6% of Thulium patients required readmission within 90 days [28], and the Global Greenlight Group found nearly identical 30-day readmission rates of 13.91% without a median lobe versus 13.08% with one (p=0.66) [26]. Bleeding complication rates followed a similar pattern. The overall blood transfusion rate was 0.73% in those with a median lobe compared to 0.93% in those without (p=0.6). This study's strengths include using a large, multicenter real-world database (ICARUS), focusing on median lobe anatomy, and assessing perioperative and functional outcomes comprehensively. However, there are also multiple limitations in this study. This study’s retrospective design limits the ability to draw causal inferences and introduces potential sources of bias. Missing data is an inherent limitation of large, retrospective real-world studies. Incomplete data, common in large, observational datasets, raises the possibility of non-random missingness, which could skew results and affect generalizability. Additionally, the exact degree of traditional posterior “median lobe” IPP versus anterolateral IPP was not recorded precisely in ICARUS. Additional differences could be present if these were measured differently. Ejaculatory dysfunction rates were not measured by a standardized patient reported outcome measure such as the MSHQ-EjD. Finally, due to the retrospective, multi-institutional case-series design, complication, readmission, and retreatment rates may be underreported. More accurate capture of these outcomes typically requires prospective studies with dedicated research staff to contact patients during follow-up or via comprehensive registry-based follow-up. CONCLUSIONS In conclusion, our retrospective real-world international database demonstrated that Aquablation provides consistent efficacy and safety in treating BPH in patients with and without median lobes. Notably, treatment with Aquablation achieved significant functional improvements while maintaining favorable perioperative outcomes, reinforcing its adaptability to various anatomical challenges. These findings show Aquablation’s role as a safe and effective treatment option for BPH across different prostate anatomies. Future studies should focus on long-term outcomes to determine the durability of Aquablation’s benefits in patients with median lobes. Comparative studies in patients with a median lobe comparing Aquablation to other surgical techniques such as HoLEP, GreenLight PVP, and TURP would further define comparative advantages in managing complex anatomical cases. Additionally, it is essential to stratify median lobe characteristics using a standardized, validated tool, based on size, degree, and location of intravesical extension, to better understand potential impact on outcomes. Declarations Disclosures: T. Rodrigues Consultant/proctor for Procept. S. H. Marhamati Consultant/investigator for Procept Biorobotics Consultant for Strauss Surgical A. P. Glaser Consultant for Procept Biorobotics and Sumitomo Pharma America, Inc. Medical Advisory Board for Emano Flow Inc. Investigator for Olympus, Zenflow Inc., Astellas, Fellow K. C. Zorn Consultant/proctor for Procept, Boston Scientific, Laborie, Olympus, Zenflow B. T. Helfand Consultant for Procept Biorobotics Investigator for Olympus, Zenflow Inc., Astellas, Fellow, Blue Earth Diagnostics Ltd. The authors declare that there are no financial conflicts of interest related to thd research, data analysis or findings discussed in this manuscript. Funding: None Competing interests: None Ethics Approval Declaration: The study was IRB approved at Endeavor Health (EH20-122). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent to Participate: Informed consent was obtained from all individual participants included in the study. Data Availability Statement: The data analyzed in this study will not be made publicly available. References Abdelmoteleb H, Jefferies ER, Drake MJ. Assessment and management of male lower urinary tract symptoms (LUTS). International Journal of Surgery . 2016/01/01/ 2016;25:164-171. doi: https://doi.org/10.1016/j.ijsu.2015.11.043 Bouhadana D, Nguyen DD, Zorn KC, Elterman DS, Bhojani N. Patient Perspectives on Benign Prostatic Hyperplasia Surgery: A Focus on Sexual Health. J Sex Med . 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Safety profile of treatment with greenlight versus Thulium Laser for benign prostatic hyperplasia. Arch Ital Urol Androl . Feb 22 2023;95(1):11101. doi: https://doi.org/10.4081/aiua.2023.11101 Tables Table 1: Demographics and Baseline Variables Men without median lobe (N=755) Men with median lobe (N=1244) p N N Age, years, mean (SD) 754 70.34 (8.08) 1237 68.49 (7.96) <.0001 DM2 (n, %) 265 48 (18.11%) 312 40 (12.82%) 0.08 CVD (n, %) 95 14 (14.74%) 142 17 (11.97%) 0.54 Anxiety/Depression (n, %) 264 51 (19.32%) 311 48 (15.43%) 0.22 OSA (n, %) 217 63 (29.03%) 253 48 (18.97%) 0.0105 Autoimmune disease (n, %) 95 5 (5.26%) 142 6 (4.23%) 0.76 Family history of BPH (n, %) 194 53 (27.32%) 202 68 (33.66%) 0.17 HbA1c, median (IQR) 80 5.60 (5.40-6.05) 111 5.60 (5.30-6.00) 0.57 PSA, median (IQR) 466 3.71 (1.96-6.49) 911 3.74 (1.94-6.50) 0.91 PHI, median (IQR) 162 30.27 (22.25-37.81) 209 31.87 (24.65-42.22) 0.12 Baseline medication use (n, %) Alpha adrenergic antagonist 289 201 (70%) 375 277 (74%) 0.22 5ARI 289 52 (18%) 375 76 (20%) 0.46 PDE5i 244 38 (16%) 323 47 (15%) 0.74 Anticholinergic/B3 289 12 (4%) 375 19 (5%) 0.58 Prostate volume, mL, median (IQR) 753 76 (54-106) 1239 80 (60-111) 0.0087 Anticoagulation, any (n, %) 289 91 (31%) 377 84 (22%) 0.0075 Aspirin 81mg (n, %) 227 37 (16%) 286 43 (15%) 0.70 Other antiplatelet agent eg clopidogrel, prasugrel (n, %) 227 12 (5%) 286 7 (2%) 0.09 Direct oral anticoagulant or warfarin (n, %) 227 29 (13%) 286 26 (9%) 0.18 Prior BPH surgery (n, %) No 585 534 (91.3%) 1158 1114 (96.2%) 0.0001 Prostate artery embolization 1 (0.17%) 5 (0.43%) Photovaporization of prostate 11 (1.88%) 7 (0.60%) Robotic simple prostatectomy 1 (0.17%) 1 (0.09%) Rezum 8 (1.37%) 15 (1.30%) Transurethral incision of prostate 1 (0.17%) 0 (0%) Transurethral microwave thermotherapy 1 (0.17%) 0 (0%) Transurethral resection of prostate 12 (2.05%) 8 (0.69%) Urolift 15 (2.56%) 8 (0.69%) Aquablation 1 (0.17%) 0 (0%) Baseline Qmax, mL/sec, median (IQR) 329 8.10 (5.40-12.00) 660 8.20 (5.30-12.45) 0.91 Baseline PVR, mL, median (IQR) 477 101 (35-220) 821 115 (48-226) 0.0393 Baseline Patient Reported Outcomes IPSS, mean (SD) 516 20.56 (7.32) 1018 20.52 (7.67) 0.93 IPSS-QOL, median (IQR) 223 4 (3-5) 280 4.50 (3-5) 0.67 SHIM, mean (SD) 268 14.06 (8.30) 562 15.01 (7.88) 0.11 DM2 = Diabetes Mellitus Type 2. CVD = Cardiovascular Disease. OSA = Obstructive Sleep Apnea. HbA1c = Hemoglobin A1c. PSA = Prostate-Specific Antigen. PHI = Prostate Health Index. 5ARI = 5-Alpha Reductase Inhibitor. PDE5i = Phosphodiesterase Type 5 Inhibitor. Qmax = Maximum Urinary Flow Rate. PVR = Post-Void Residual. IPSS = International Prostate Symptom Score. QOL = Quality of Life. SHIM = Sexual Health Inventory for Men Table 2: Operative Characteristics and Complications Men without median lobe (N=755) Men with median lobe (N=1244) p N N Total OR Time, min, median (IQR) 661 49 (37-64) 1192 58 (45-73) [AG1] <.0001 Aquablation time, min, median (IQR) 248 6 (5 - 8) 317 7 (6 - 9) <.0001 Takeback for cystoscopy with clot evacuation (n, %) 755 15 (2%) 1238 27 (2.2%) 0.77 Blood transfusion (n, %) 755 7 (0.9%) 1239 9 (0.7%) 0.63 30-day readmission (n, %) 425 7 (1.7%) 983 7 (0.7%) 0.14 Clavien-Dindo Complications (n, %) Clavien 0 733 663 (90.4%) 1200 1049 (87.4%) 0.07 Clavien I 45 (6.1%) 98 (8.2%) Clavien II 9 (1.2%) 13 (1.1%) Clavien III 15 (2.1%) 40 (3.3%) Table 3: Long Term Follow-Up Men without median lobe (N=755) Men with median lobe (N=1244) p N N Improvement in LUTS (1-3m) Post-Op Qmax, mL/sec, median (IQR) 182 19.05 (14.50-25.90) 440 19.55 (14.90-26.00) 0.59 change Qmax 148 12.06 (10.64) 348 12.13 (12.02) 0.96 % change in Qmax 143 234.00 (297.90) 331 235.34 (332.61) 0.97 Post Op PVR, mL (median, IQR) 482 22 (6-67) 950 26 (6-59) 0.95 change in PVR 416 -144.89 (239.67) 746 -149.46 (230.31) 0.75 % change in PVR 400 -39.53 (147.87) 725 -43.43 (159.80) 0.60 Post Op IPSS, 429 9.93 (6.87) 771 9.35 (6.36) 0.14 Change in IPSS 331 -10.17 (9.09) 681 -10.93 (8.95) 0.21 % change in IPSS 330 -40.52 (59.47) 675 -47.59 (52.10) 0.07 Post Op IPSS-QOL 172 2.00 (1.00-3.00) 215 2.00 (1.00-3.00) 0.45 Change in IPSS-QOL 144 -1.96 (2.20) 190 -2.31 (2.07) 0.13 % change in IPSS-QOL 144 -38.38 (54.97) 188 -46.64 (50.99) 0.16 Post Op SHIM 255 14.56 (8.86) 423 14.01 (8.65) 0.43 Change in SHIM 172 0.27 (4.53) 327 -0.35 (5.47) 0.18 % change in SHIM 171 25.57 (132.58) 325 19.37 (179.07) 0.66 Retrograde ejaculation (n, %) No 174 157 (90.23%) 357 276 (77.31%) 0.0002 Reduced or Decreased 3 (1.72%) 41 (11.48%) Yes 14 (8.05%) 40 (11.20%) Post Op PSA 217 2.08 (1.02-3.32) 400 2.06 (1.01-3.70) 0.70 change in PSA 193 -2.69 (4.47) 359 -2.88 (5.39) 0.65 % change in PSA 193 -37.10 (43.66) 359 -35.87 (52.39) 0.77 Post Op PHI 104 26.92 (19.11-34.36) 149 25.70 (18.87-37.24) 0.85 change in PHI 89 -2.38 (10.62) 113 -6.93 (14.53) 0.0111 % change in PHI 89 -0.89 (36.31) 113 -3.41 (146.35) 0.76 Improvement in LUTS (4-8m) Post Op IPSS 204 7.56 (5.56) 403 7.27 (5.66) 0.55 Change in IPSS 186 -11.53 (8.47) 370 -12.64 (8.07) 0.13 % change in IPSS 185 -52.39 (63.49) 367 -59.09 (40.78) 0.19 Post Op IPSS-QOL 114 2 (1-3) 115 2 (1-3) [AG3] 0.59 Change in IPSS-QOL 95 -2.38 (1.83) 83 -2.31 (2.04) 0.82 % change in IPSS-QOL 95 -52.70 (40.30) 83 -50.38 (46.23) 0.72 Improvement in LUTS (9-12m) Post Op IPSS 36 6.67 (5.47) 124 5.65 (5.27) 0.31 Change in IPSS 34 -14.44 (7.91) 114 -13.55 (8.45) 0.59 % change in IPSS 34 -65.82 (27.16) 114 -67.53 (31.94) 0.78 Post Op IPSS-QOL 8 2.50 (1.50-4.50) 27 2.00 (1.00-5.00) 0.45 Change in IPSS-QOL 6 -1.83 (1.94) 22 -1.23 (3.70) 0.70 % change in IPSS-QOL 6 -38.89 (37.88) 20 -34.25 (70.64) 0.88 Improvement in LUTS (13-24m) Post Op IPSS 126 7.49 (6.40) 210 6.59 (5.76) 0.18 Change in IPSS 115 -11.34 (8.71) 184 -13.09 (8.66) 0.09 % change in IPSS 115 -54.91 (43.73) 181 -56.95 (120.08) 0.84 Post Op IPSS-QOL 69 2.00 (1.00-3.00) 98 2.00 (1.00-2.00) 0.17 Change in IPSS-QOL 46 -1.80 (1.81) 54 -2.22 (1.77) 0.25 % change in IPSS-QOL 46 -42.10 (56.72) 54 -52.50 (51.33) 0.34 LUTS = Lower Urinary Tract Symptoms. Qmax = Maximum Urinary Flow Rate. PVR = Post-Void Residual. IPSS = International Prostate Symptom Score. QOL = Quality of Life. SHIM = Sexual Health Inventory for Men. PSA = Prostate-Specific Antigen. PHI = Prostate Health Index Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":38396,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eQmax and PVR improvement after Aquablation by median lobe presence.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7521461/v1/59e0ad39a40449b6e890591b.png"},{"id":91938121,"identity":"f8e8dab3-6af7-47c3-9c6f-1735c9587a69","added_by":"auto","created_at":"2025-09-23 03:05:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":74198,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIPSS and IPSS-QoL improvement over time after Aquablation by median lobe presence.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7521461/v1/bc8164a2c18322d560ced29c.png"},{"id":94197063,"identity":"69d27ab1-1eb2-4d39-996c-58b448385f1e","added_by":"auto","created_at":"2025-10-23 13:17:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1925990,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7521461/v1/6f0dcc14-98d1-49c4-a818-6a653e668ca2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Median Lobe Presence on Clinical Outcomes Following Aquablation: an analysis of the International Collaborative Aquablation Research Urology Society (ICARUS) database","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAquablation is an innovative surgical treatment for benign prostatic hyperplasia (BPH) that combines real-time ultrasound guidance with robotic high-velocity saline jets to resect prostate tissue. Lower urinary tract symptoms (LUTS) secondary to BPH include a range of storage and voiding symptoms that significantly impact patients’ quality of life \u003csup\u003e1-3\u003c/sup\u003e. Management options vary widely, from lifestyle modifications and pharmacotherapy to procedural interventions, with transurethral resection of the prostate (TURP) widely considered the gold standard surgical procedure [1,4,5]. Minimally invasive procedures such as UroLift and Rezum can preserve ejaculatory function, but on average do not achieve the same degree of LUTS improvement as resective procedures such as TURP [6,7]. Aquablation has gained popularity for its ability to preserve sexual function while successfully improving LUTS to a degree similar to or better than TURP [2,8,9].\u003c/p\u003e\n\u003cp\u003eA median lobe, or intravesical prostatic protrusion (IPP), is an extension of the prostate’s transition zone into the bladder and contributes to more severe obstructive urinary symptoms. This obstruction often occurs due to a “ball-valve” effect, where the protruding median lobe obstructs urine flow, increasing bladder outlet obstruction and inhibiting the funnel effect of the bladder neck during urination [10].\u003c/p\u003e\n\u003cp\u003eMedian lobe enlargement is prevalent and presents unique challenges in BPH management, affecting 30% of a cohort of men aged 40–79 with an IPP of 1–9 mm and 10% with an IPP ≥ 10 mm [11]. Traditional pharmacologic therapies may be less effective in patients with significant median lobe enlargement, leading to poorer outcomes compared to those without such anatomical variations. For instance, high IPP grades are associated with a higher risk of treatment resistance, increased risk of urinary tract infections, acute urinary retention, or the need for prostatic surgery [12]. This shows the importance of considering median lobe presence in treatment planning.\u003c/p\u003e\n\u003cp\u003eCurrently, limited data are available on the perioperative and long-term functional outcomes of Aquablation specifically in patients with median lobe enlargement. Aquablation has demonstrated consistent efficacy and safety compared to TURP across different prostate sizes, primarily in the WATER and WATER II pivotal trials [9,13,14]. However, these studies did not stratify outcomes based on detailed intraprostatic anatomy, such as median lobe presence. \u003c/p\u003e\n\u003cp\u003eA key advantage of Aquablation is its precision in preserving critical anatomical structures, which helps maintain ejaculatory function. Careful contour planning, as emphasized by Nguyen et al. (2021), may improve postoperative ejaculation function by avoiding excessive resection near the verumontanum or ejaculatory ducts [15]. Given its ability to precisely and selectively resect tissue, Aquablation may offer superior outcomes in median lobe cases by effectively relieving obstruction while minimizing damage to surrounding structures.\u003c/p\u003e\n\u003cp\u003eWhile existing research supports Aquablation’s safety and efficacy, the impact of the median lobe on perioperative outcomes and postoperative recovery remains underexplored. Given its anatomical challenges, we hypothesize that the presence of a median lobe may influence surgical outcomes, including operative time, complication rates, and functional outcomes such as symptom relief and postoperative recovery. By analyzing real-world data, this study aims to clarify these effects, providing insights into the overall effectiveness and safety of Aquablation therapy for patients with a median lobe, and its role as a patient-centered treatment for BPH.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis retrospective, multicenter study utilized data from the International Collaborative Aquablation Research Urology Society (ICARUS) database, a comprehensive multicenter IRB-approved international registry of men undergoing Aquablation from 2019-2023 (EH20-122). \u003c/p\u003e\n\u003cp\u003eAquablation procedures were performed using two passes and focal bladder neck cautery [16]. Median lobes were identified on cystoscopy and real-time ultrasound imaging during Aquablation and contoured for resection with the high-velocity waterjet using the Aquablation system. Preoperative data collection encompassed patient demographics and medication use, including alpha-blockers, 5-alpha-reductase inhibitors, daily phosphodiesterase type 5 inhibitors, and anticoagulants. Laboratory values such as serum Prostate Specific Antigen (PSA) and Prostate Health Index (PHI) were recorded, along with prostate volume measurements and any history of prior surgical interventions for BPH. \u003c/p\u003e\n\u003cp\u003eBaseline clinical parameters included maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), and patient-reported outcomes including the International Prostate Symptom Score (IPSS), IPSS quality of life (QoL) domain, and Sexual Health Inventory for Men (SHIM). Because the Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD) was not consistently administered across the ICARUS database, ejaculatory function was instead documented categorically at each site as one of the following: normal antegrade ejaculation, antegrade ejaculation with reduced or diminished volume, or retrograde ejaculation. Patients were divided into two groups based on the intra-operative presence or absence of a median lobe, as determined by the surgeon. \u003c/p\u003e\n\u003cp\u003eThe primary endpoints for the study included the IPSS and IPSS-QoL questionnaires assess at regular intervals (1-3, 4-8, 9-12 and 13-24 months) postoperatively. Secondary evaluations included PSA levels, PHI, PVR, Qmax, and SHIM. Retrograde ejaculation rates were also documented as part of the postoperative follow-up. Operative characteristics such as Aquablation and total operative time, blood transfusion rates, surgical complications as classified on the Clavien-Dindo scale, and 30-day readmission rates, were also recorded.\u003c/p\u003e\n\u003cp\u003eBaseline characteristics and outcome measures were summarized using descriptive statistics. Continuous variables were expressed as means ± standard deviations or medians with interquartile ranges as appropriate and compared using ANOVA for normally distributed data or the Kruskal-Wallis test for non-normal distributions. Categorical variables were reported as frequencies and percentages and analyzed using the Chi-square test or Fisher’s exact test when appropriate. Statistical significance was set at p\u0026lt;0.05 for all analyses. Statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC) and R version 4.3.2.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAmong the 1,999 patients, 62% (n=1244) had a median lobe and 38% (n=755) did not. The median age at time of surgery was slightly lower in the median lobe group (68 years vs. 70 years; p\u0026lt;0.0001). The median prostate volume was larger in the median lobe group with a median size of 80mL (IQR 60-110) compared to 76mL (54-106) in the group without a median lobe (p=0.009). Men with a median lobe were less likely to have undergone prior BPH surgery (4% vs 9%; p=0.001. Baseline PVR was slightly higher in the median lobe group (115mL vs. 101mL; p=0.0393), but baseline Qmax was similar between groups (8.2mL/sec vs 8.1mL/sec; p=0.91). Additional baseline characteristics are listed in \u003cstrong\u003eTable 1.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTotal operative times were significantly longer in the median lobe group, with a median total operative time of 58 minutes compared to 49 minutes in the group without median lobes (p\u0026lt;0.0001). Similarly, Aquablation time was 7 minutes in the median lobe group compared to 6 minutes in the group without median lobes (p\u0026lt;0.0001; \u003cstrong\u003eTable 2\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere was no difference in bleeding complication rates based on the presence of a median lobe. The rate of takebacks for cystoscopy or clot evacuation was 2.18% in the median lobe group and 1.99% in the group without a median lobe (p=0.77). Blood transfusion rates were 0.73% and 0.93%, in both groups respectively (p=0.63). There was also no statistically significant difference in rates of 30-days readmissions between the groups, 0.71% in the median lobe group compared to 1.65% in the group without a median lobe (p=0.14). Both groups had similar rates of Clavien-Dindo complications, 12.6% in the median lobe group compared to 9.56% in the group without (p=0.07).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBoth groups demonstrated substantial post-operative functional improvements at 1-3 months follow up (\u003cstrong\u003eTable 3)\u003c/strong\u003e. PVR decreased similarly across both groups, with a median reduction of 149mL in the median lobe group and 145mL in the group without a median lobe (p=0.75; \u003cstrong\u003eFigure 1A\u003c/strong\u003e). Postoperative SHIM scores were also similar in both groups. Qmax increased by a mean of 12 mL/s in both groups (p=0.96; \u003cstrong\u003eFigure 1B\u003c/strong\u003e). Improvements in IPSS and IPSS-QoL were similar throughout follow-up regardless of the presence of a median lobe (\u003cstrong\u003eFigure 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eRates of retrograde ejaculation were higher in the median lobe group (11.2% vs. 8.1%; p=0.0002). Postoperative reductions in PSA levels were similar, with median PSA decrease of 2.88 ng/mL in the median lobe group compared to 2.69 ng/mL in the group without a median lobe (p=0.65). There was a larger reduction in PHI for men with a median lobe compared to men without a median lobe (6.93 vs. 2.38; p=0.0111).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis represents the largest real-world study to date examining Aquablation and the influence of a median lobe. Our findings indicate that despite the anatomical challenges associated with the presence of a median lobe, functional improvements including reduction of IPSS, IPSS-QoL and PVR as well as increases in Qmax are comparable over the long term between patients undergoing Aquablation with a median lobe to those without one. However, the presence of a median lobe was associated with a slightly longer operative time (9 minutes) and a slightly higher rate of retrograde ejaculation (11% vs 8%). While statistically significant, these small differences may not be clinically significant and warrant replication before broad conclusions should be made. Overall, our results reinforce the versatility of Aquablation and its ability to accommodate anatomical variations without compromising efficacy or safety.\u003c/p\u003e\n\u003cp\u003eThe slightly longer operative times in patients with a median lobe were expected due to the additional anatomical challenge posed by the median lobe, but this did not negatively affect functional outcomes. Previous studies have shown that Aquablation requires less operative time than GreenLight Photovaporization (PVP), Thulium Laser Enucleation of the Prostate (ThuLEP), GreenLight Laser Enucleation of the Prostate (GreenLEP), and Holmium Laser Enucleation of the prostate (HoLEP) [17]. Aquablation demonstrated the shortest operative time across all prostate volumes, with a slope of 0.16 min/g compared to 0.32 min/g for GreenLEP, 0.28 min/g for HoLEP, 0.32 min/g for ThuLEP, and 0.63 min/g for PVP. In comparison, a review article by Tokarski et al. (2021) demonstrated that Aquablation offers operative times similar to TURP and shorter than HoLEP, while maintaining comparable efficacy and safety outcomes [18]. Additionally, the WATER trial showed no significant difference in overall mean operative time between Aquablation and TURP, with a significantly shorter resection time using Aquablation (4 vs. 27 min, p\u0026lt;0.0001) [13]. Overall, even with the slight increase in procedure time for median lobe anatomy, Aquablation remains a time efficient treatment modality.\u003c/p\u003e\n\u003cp\u003eOur study did show slightly higher rates of retrograde ejaculation in patients with a median lobe (11.2% vs. 8.1%, p=0.0002). This aligns with findings from the literature indicating that anatomical factors, such as bladder neck involvement, may contribute to ejaculatory dysfunction. Previous studies have shown that preservation of the bladder neck during TURP significantly reduces retrograde ejaculation rates compared to standard TURP, likely due to the protection of smooth muscle fibers that facilitate bladder neck closure [19]. While Aquablation preserves the bladder neck, we could hypothesize that more aggressive treatment of IPP and the bladder neck may be associated with slightly higher risks of ejaculatory dysfunction. However, the overall rate of ejaculatory dysfunction is low in both groups, and is comparable to rates reported in the literature after Aquablation [14,20,21].\u003c/p\u003e\n\u003cp\u003eAlthough the presence of a median lobe may add complexity to the procedure, our real-world study demonstrates that voiding outcomes including IPSS, IPSS-QoL, PVR, and Qmax were unaffected. This supports Aquablation’s applicability in anatomically complex cases, further distinguishing it from traditional methods like TURP, which are associated with high rates of ejaculatory dysfunction and complications [22-24]. These findings align with previous studies, including the WATER trials, which demonstrated sustained improvements in LUTS with IPSS, IPSS-QoL, PVR, and Qmax, along with minimal impact on ejaculatory function across prostate sizes, even over extended follow-up periods [9,13,14]. Real-world data and a French clinical registry further emphasized the effectiveness of Aquablation for treating BPH, complementing the findings of both WATER trials [21,25]. \u003c/p\u003e\n\u003cp\u003eMoreover, our results are compatible with findings from other modalities. For example, Nguyen et al. analyzed the impact of a median lobe on GreenLight PVP outcomes using a large international database [26]. While they found a slightly longer operative time for median lobe cases, functional outcomes such as IPSS and Qmax were comparable between groups. However, unlike GreenLight PVP, Aquablation provides a robotically controlled, automated approach, potentially reducing operator variability and enhancing precision. Overall, our findings indicate no major functional differences between both groups, further supporting the broad applicability of Aquablation in patients with diverse anatomical variations.\u003c/p\u003e\n\u003cp\u003eIn our study, 30-day readmission rates, Clavien–Dindo complications and blood transfusion rates were comparable between patients with and without a median lobe, indicating that the anatomical complexity did not increase perioperative risk. Specifically, 30-day readmission rates were 0.71% for patients with a median lobe and 1.65% for those without one (p=0.14). By comparison, a registry of 3,059 men undergoing elective TURP reported a 7.4% 30-day readmission rate [27]. Among laser-based treatments, 24% of GreenLight PVP and 26.6% of Thulium patients required readmission within 90 days [28], and the Global Greenlight Group found nearly identical 30-day readmission rates of 13.91% without a median lobe versus 13.08% with one (p=0.66) [26]. Bleeding complication rates followed a similar pattern. The overall blood transfusion rate was 0.73% in those with a median lobe compared to 0.93% in those without (p=0.6).\u003c/p\u003e\n\u003cp\u003eThis study's strengths include using a large, multicenter real-world database (ICARUS), focusing on median lobe anatomy, and assessing perioperative and functional outcomes comprehensively. However, there are also multiple limitations in this study. This study’s retrospective design limits the ability to draw causal inferences and introduces potential sources of bias. Missing data is an inherent limitation of large, retrospective real-world studies. Incomplete data, common in large, observational datasets, raises the possibility of non-random missingness, which could skew results and affect generalizability. Additionally, the exact degree of traditional posterior “median lobe” IPP versus anterolateral IPP was not recorded precisely in ICARUS. Additional differences could be present if these were measured differently. Ejaculatory dysfunction rates were not measured by a standardized patient reported outcome measure such as the MSHQ-EjD. Finally, due to the retrospective, multi-institutional case-series design, complication, readmission, and retreatment rates may be underreported. More accurate capture of these outcomes typically requires prospective studies with dedicated research staff to contact patients during follow-up or via comprehensive registry-based follow-up.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIn conclusion, our retrospective real-world international database demonstrated that Aquablation provides consistent efficacy and safety in treating BPH in patients with and without median lobes. Notably, treatment with Aquablation achieved significant functional improvements while maintaining favorable perioperative outcomes, reinforcing its adaptability to various anatomical challenges. These findings show Aquablation’s role as a safe and effective treatment option for BPH across different prostate anatomies.\u003c/p\u003e\n\u003cp\u003eFuture studies should focus on long-term outcomes to determine the durability of Aquablation’s benefits in patients with median lobes. Comparative studies in patients with a median lobe comparing Aquablation to other surgical techniques such as HoLEP, GreenLight PVP, and TURP would further define comparative advantages in managing complex anatomical cases. Additionally, it is essential to stratify median lobe characteristics using a standardized, validated tool, based on size, degree, and location of intravesical extension, to better understand potential impact on outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eDisclosures:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eT. Rodrigues\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eConsultant/proctor for Procept.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eS. H. Marhamati\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eConsultant/investigator for Procept Biorobotics\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eConsultant for Strauss Surgical \u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eA. P. Glaser \u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eConsultant for Procept Biorobotics and\u0026nbsp;Sumitomo Pharma America, Inc.\u003c/li\u003e\n \u003cli\u003eMedical Advisory Board for Emano Flow Inc.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eInvestigator for Olympus, Zenflow Inc., Astellas, Fellow\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eK. C. Zorn\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eConsultant/proctor for Procept, Boston Scientific, Laborie, Olympus, Zenflow\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eB. T. Helfand\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eConsultant for Procept Biorobotics\u003c/li\u003e\n \u003cli\u003eInvestigator for Olympus, Zenflow Inc., Astellas, Fellow, Blue Earth Diagnostics Ltd.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors declare that there are no financial conflicts of interest related to thd research, data analysis or findings discussed in this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding:\u003c/u\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests:\u003c/u\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eEthics Approval Declaration:\u003c/u\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was IRB approved at Endeavor Health (EH20-122).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent to Participate:\u003c/u\u003e Informed consent was obtained from all individual participants included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eData Availability Statement:\u003c/u\u003e The data analyzed in this study will not be made publicly available.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdelmoteleb H, Jefferies ER, Drake MJ. 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Reasons to overthrow TURP: bring on Aquablation. \u003cem\u003eWorld Journal of Urology\u003c/em\u003e. 2021/7// 2021;39:2291-2299. doi:10.1007/s00345-020-03390-x\u003c/li\u003e\n\u003cli\u003ePlante M, Gilling P, Barber N, et al. Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial. \u003cem\u003eBJU International\u003c/em\u003e. 2019/4// 2019;123:651-660. doi: https://doi.org/10.1111/bju.14426\u003c/li\u003e\n\u003cli\u003eOmidele OO, Siegal AS, Roshandel R, Te AE, Kaplan SA. Aquablation at 4-years: Real World Data From the Largest Single-center Study With Associated Outcomes Follow-up. \u003cem\u003eUrology\u003c/em\u003e. 2024;194:216-220. doi: https://doi.org/10.1016/j.urology.2024.07.047\u003c/li\u003e\n\u003cli\u003eNguyen DD, Sadri I, Law K, et al. Impact of the presence of a median lobe on functional outcomes of greenlight photovaporization of the prostate (PVP): an analysis of the Global Greenlight Group (GGG) Database. \u003cem\u003eWorld J Urol\u003c/em\u003e. Oct 2021;39(10):3881-3889. doi: https://doi.org/10.1007/s00345-020-03529-w\u003c/li\u003e\n\u003cli\u003eShamout S, Carlson K, Brotherhood HL, Crump T, Baverstock R. Incidence and predictors of early and late hospital readmission after transurethral resection of the prostate: a population-based cohort study. \u003cem\u003eBJU Int\u003c/em\u003e. Feb 2021;127(2):238-246. doi: https://doi.org/10.1111/bju.15191\u003c/li\u003e\n\u003cli\u003eCampobasso D, Barbieri A, Bocchialini T, et al. Safety profile of treatment with greenlight versus Thulium Laser for benign prostatic hyperplasia. \u003cem\u003eArch Ital Urol Androl\u003c/em\u003e. Feb 22 2023;95(1):11101. doi: https://doi.org/10.4081/aiua.2023.11101\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDemographics and Baseline Variables\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"669\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen without median lobe\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=755)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen with median lobe\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=1244)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years, mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e70.34 (8.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e1237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e68.49 (7.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDM2 (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e48 (18.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e40 (12.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCVD (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e14 (14.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e17 (11.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety/Depression (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e51 (19.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e48 (15.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOSA (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e63 (29.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e48 (18.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0105\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAutoimmune disease (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (5.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (4.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history of BPH (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e53 (27.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e68 (33.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1c, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e5.60 (5.40-6.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e5.60 (5.30-6.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSA, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3.71 (1.96-6.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3.74 (1.94-6.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePHI, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e30.27 (22.25-37.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e31.87 (24.65-42.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eBaseline medication use (n, %)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 461px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Alpha adrenergic \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; antagonist\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e201 (70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e277 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; 5ARI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e52 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e76 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; PDE5i\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e38 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e47 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Anticholinergic/B3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e12 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e19 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProstate volume, mL, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e76 (54-106)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e1239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e80 (60-111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0087\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnticoagulation, any (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e91 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e84 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0075\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAspirin 81mg (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e37 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e43 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther antiplatelet agent eg clopidogrel, prasugrel (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e12 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect oral anticoagulant or warfarin (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e29 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e26 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003ePrior BPH surgery (n, %)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 461px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"10\" style=\"width: 49px;\"\u003e\n \u003cp\u003e585\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e534 (91.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"10\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1114 (96.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"10\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Prostate artery embolization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (0.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Photovaporization of prostate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e11 (1.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (0.60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Robotic simple prostatectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Rezum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e8 (1.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e15 (1.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Transurethral incision of prostate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Transurethral microwave thermotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Transurethral resection of prostate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e12 (2.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e8 (0.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Urolift\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e15 (2.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e8 (0.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Aquablation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline Qmax, mL/sec, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e8.10 (5.40-12.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e8.20 (5.30-12.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline PVR, mL, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e101 (35-220)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e115 (48-226)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0393\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eBaseline Patient Reported Outcomes\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 461px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIPSS, mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e20.56 (7.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e1018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e20.52 (7.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIPSS-QOL, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e4.50 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSHIM, mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e14.06 (8.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e15.01 (7.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eDM2\u003c/strong\u003e = Diabetes Mellitus Type 2. \u003cstrong\u003eCVD\u003c/strong\u003e = Cardiovascular Disease. \u003cstrong\u003eOSA\u003c/strong\u003e = Obstructive Sleep Apnea. \u003cstrong\u003eHbA1c\u003c/strong\u003e = Hemoglobin A1c. \u003cstrong\u003ePSA\u003c/strong\u003e = Prostate-Specific Antigen. \u003cstrong\u003ePHI\u003c/strong\u003e = Prostate Health Index. \u003cstrong\u003e5ARI\u003c/strong\u003e = 5-Alpha Reductase Inhibitor. \u003cstrong\u003ePDE5i\u003c/strong\u003e = Phosphodiesterase Type 5 Inhibitor. \u003cstrong\u003eQmax\u003c/strong\u003e = Maximum Urinary Flow Rate. \u003cstrong\u003ePVR\u003c/strong\u003e = Post-Void Residual. \u003cstrong\u003eIPSS\u003c/strong\u003e = International Prostate Symptom Score. \u003cstrong\u003eQOL\u003c/strong\u003e = Quality of Life. \u003cstrong\u003eSHIM\u003c/strong\u003e = Sexual Health Inventory for Men\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Operative Characteristics and Complications\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"680\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen without median lobe\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=755)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen with median lobe\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=1244)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal OR Time, min, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e49 (37-64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e58 (45-73)\u003ca id=\"_anchor_1\" href=\"#_msocom_1\" language=\"JavaScript\" name=\"_msoanchor_1\"\u003e[AG1]\u003c/a\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAquablation time, min, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e6 (5 - 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (6 - 9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTakeback for cystoscopy with clot evacuation (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e755\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e15 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e1238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e27 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood transfusion (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e755\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e7 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e1239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e9 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30-day readmission (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e7 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eClavien-Dindo Complications (n, %)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 454px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Clavien 0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 49px;\"\u003e\n \u003cp\u003e733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e663 (90.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1049 (87.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Clavien I\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e45 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e98 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Clavien II\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e9 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e13 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Clavien III\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e15 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e40 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Long Term Follow-Up\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"678\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen without median lobe\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=755)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen with median lobe\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=1244)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eImprovement in LUTS (1-3m)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 442px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-Op Qmax, mL/sec, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e19.05 (14.50-25.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e440\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e19.55 (14.90-26.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003echange Qmax\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e12.06 (10.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e12.13 (12.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in Qmax\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e234.00 (297.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e235.34 (332.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op PVR, mL (median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e22 (6-67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e26 (6-59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003echange in PVR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-144.89 (239.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-149.46 (230.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in PVR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-39.53 (147.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-43.43 (159.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op IPSS,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e9.93 (6.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e9.35 (6.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-10.17 (9.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-10.93 (8.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-40.52 (59.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-47.59 (52.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.00 (1.00-3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e2.00 (1.00-3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-1.96 (2.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-2.31 (2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-38.38 (54.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-46.64 (50.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op SHIM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e14.56 (8.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e14.01 (8.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in SHIM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.27 (4.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-0.35 (5.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in SHIM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e25.57 (132.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e19.37 (179.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetrograde ejaculation (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 40px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e157 (90.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003e357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e276 (77.31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Reduced or Decreased\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3 (1.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e41 (11.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e14 (8.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e40 (11.20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op PSA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.08 (1.02-3.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e2.06 (1.01-3.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003echange in PSA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-2.69 (4.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-2.88 (5.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in PSA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-37.10 (43.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-35.87 (52.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op PHI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e26.92 (19.11-34.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e25.70 (18.87-37.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003echange in PHI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-2.38 (10.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-6.93 (14.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0111\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in PHI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-0.89 (36.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-3.41 (146.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eImprovement in LUTS (4-8m)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 442px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e7.56 (5.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e7.27 (5.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-11.53 (8.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-12.64 (8.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-52.39 (63.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-59.09 (40.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e2 (1-3)\u003ca id=\"_anchor_3\" href=\"#_msocom_3\" language=\"JavaScript\" name=\"_msoanchor_3\"\u003e[AG3]\u003c/a\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-2.38 (1.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-2.31 (2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-52.70 (40.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-50.38 (46.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eImprovement in LUTS (9-12m)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 442px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e6.67 (5.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e5.65 (5.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-14.44 (7.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-13.55 (8.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-65.82 (27.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-67.53 (31.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.50 (1.50-4.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e2.00 (1.00-5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-1.83 (1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-1.23 (3.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-38.89 (37.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-34.25 (70.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eImprovement in LUTS\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e(13-24m)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 442px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e7.49 (6.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e6.59 (5.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-11.34 (8.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-13.09 (8.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in IPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-54.91 (43.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-56.95 (120.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Op IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.00 (1.00-3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e2.00 (1.00-2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-1.80 (1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-2.22 (1.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% change in IPSS-QOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e-42.10 (56.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-52.50 (51.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eLUTS\u003c/strong\u003e = Lower Urinary Tract Symptoms. \u003cstrong\u003eQmax\u003c/strong\u003e = Maximum Urinary Flow Rate. \u003cstrong\u003ePVR\u003c/strong\u003e = Post-Void Residual. \u003cstrong\u003eIPSS\u003c/strong\u003e = International Prostate Symptom Score. \u003cstrong\u003eQOL\u003c/strong\u003e = Quality of Life. \u003cstrong\u003eSHIM\u003c/strong\u003e = Sexual Health Inventory for Men. \u003cstrong\u003ePSA\u003c/strong\u003e= Prostate-Specific Antigen. \u003cstrong\u003ePHI\u003c/strong\u003e = Prostate Health Index\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Benign Prostatic Hyperplasia, BPH, Aquablation, Median Lobe, Urology","lastPublishedDoi":"10.21203/rs.3.rs-7521461/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7521461/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eINTRODUCTION AND OBJECTIVE:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile the efficacy of Aquablation is established for varying prostate sizes, specific outcomes in patients with a median lobe have not been well studied. We evaluated the differences in perioperative and functional outcomes in patients undergoing Aquablation with and without a median lobe.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe performed an analysis of the International Collaborative Aquablation Research Urology Society (ICARUS) database, a multicentric international database. Patients were grouped based on the presence or absence of a median lobe. Operative characteristics (operative time, adverse events) as well as functional outcomes up to 24 months postoperatively including post-void residual (PVR) volume, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and the Sexual Health Inventory for Men (SHIM) questionnaires were assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1,999 men were included: 755 (38%) patients did not have a median lobe while 1,244 patients (62%) had a median lobe. Median (IQR) prostate volumes were 76 (54-106) mL and 80 (60-110) mL for each group, respectively (p=0.009). Baseline medications, including α-blockers and 5α-reductase inhibitors (5ARIs), were similar between groups. Total operative time (49 vs. 58 min, p\u0026lt;0.0001) and Aquablation time (6.3 vs. 7.3 min, p\u0026lt;0.0001) were slightly longer for those with a median lobe. Postoperative outcomes, including improvements in IPSS, IPSS-QoL, Qmax, and PVR were similar between groups. Rates of retrograde ejaculation were slightly higher in the median lobe cohort (11.2% vs 8.1%; p=0.0002), but there were no differences in postoperative SHIM scores. Adverse events including blood transfusions did not significantly differ between groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSIONS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe presence of a median lobe does not have a significant impact on the outcomes of Aquablation in a real-world setting. Using a large multicentric international database, this study demonstrates that Aquablation provides effective symptom relief and safety for both groups.\u003c/p\u003e","manuscriptTitle":"Impact of Median Lobe Presence on Clinical Outcomes Following Aquablation: an analysis of the International Collaborative Aquablation Research Urology Society (ICARUS) database","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 03:05:07","doi":"10.21203/rs.3.rs-7521461/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f37ba49d-e0ab-4d33-9498-6028c8f5dcfa","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-23T13:08:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 03:05:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7521461","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7521461","identity":"rs-7521461","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}