To identify the iatrogenic urethral stricture rate and elucidate potential predisposing risk factors for development of urethral stricture following Aquablation.

We reviewed 170 patients that underwent Aquablation from February 2019 to September 2024. Postoperatively, a 22 Fr hematuria catheter was inserted and placed on traction with continuous bladder irrigation overnight. On postoperative day one, traction was removed, and irrigation was discontinued. If appropriate, patients underwent a void trial prior to discharge. Patients were seen for follow up at 6-week, 3-month, 9-month, and then yearly. The primary outcome was development of urethral stricture. Standard two-tailed t tests and Fisher’s exact tests were used to assess for factors affecting stricture risk.

The postprocedural urethral stricture rate was 5.3% (9/170) with 89% in the fossa navicularis and one in the bulbar urethra. Mean stricture length was 1.9 cm (1.5-2.5). Mean traction time for stricture patients was 23.7 vs 18.1 hours in nonstricture patients ( P < .001). Eighty nine percent of the stricture cohort was discharged home with a catheter, vs 47.8% in the nonstricture cohort ( P = .01). The median indwelling catheter duration was 6.5 days in stricture patients vs 1 day in the nonstricture patients ( P < .03).

The incidence of symptomatic urethral stricture after Aquablation was 5.3% and associated with longer indwelling catheter duration and longer traction time.