Aquablation is a transurethral prostate operation that uses an image-guided, robotically controlled high-velocity saline jet to remove selected obstructing tissue. Randomised evidence supports symptom and flow outcomes broadly comparable with TURP in prostates around 30-80 mL, with a better chance of preserving antegrade ejaculation. It still requires anaesthesia, haemostasis and temporary catheterisation. Prospective evidence also exists for 80-150 mL glands, but long-term randomised comparison with enucleation in large prostates is less mature.

What is Aquablation?

Aquablation combines cystoscopic access with transrectal ultrasound planning. The surgeon maps the prostate and sets treatment boundaries; the robotic system then directs a saline waterjet through the planned tissue. Blood vessels and the surgical capsule contain more collagen and tend to resist the waterjet better than glandular tissue, but active haemostasis may still be required.

The technique can treat a variety of prostate shapes, including median-lobe enlargement, because the ablation plan is created for the individual anatomy.

Who may be suitable?

The procedure should be chosen after confirming that the symptoms are genuinely related to benign prostate obstruction rather than infection, urethral narrowing, bladder disease or a weak bladder alone.

• Moderate-to-severe urinary symptoms with objective evidence of benign prostate obstruction.
• Men who want a tissue-removing treatment with a good chance of preserving ejaculation.
• Prostates in the 30-80 mL range, where the strongest randomised comparative evidence exists.
• Selected larger prostates; studies have reported durable results in glands up to about 150 mL, although evidence versus established enucleation is less mature.
• Patients with a median lobe when anatomy is suitable.

When may another treatment be better?

• Patients who cannot undergo anaesthesia or in whom operative bleeding risk is unacceptable without optimisation.
• Situations where a proven size-independent enucleation procedure is preferred for very large glands.
• A patient who requires prostate tissue for a specific diagnostic reason; Aquablation tissue may not provide the same organised resection specimen as TURP or enucleation.
• A weak bladder without meaningful outlet obstruction, where removing prostate tissue may not restore normal emptying.
• Limited access to the technology or a centre without appropriate experience.

How is the procedure done?

Under anaesthesia, a scope is passed through the urethra and an ultrasound probe images the prostate. The surgeon marks the area to be treated, including protection zones around structures that should be preserved. The robotic handpiece then delivers a high-speed saline jet to remove the mapped tissue.

After ablation, bleeding is controlled with catheter balloon pressure and/or selective cautery or laser. A urinary catheter is left while the channel settles.

Anaesthesia and hospital stay

Aquablation is normally performed under spinal or general anaesthesia. Hospital stay is often short, but discharge timing depends on bleeding, catheter status, medical conditions and local practice.

Will I need a catheter?

A catheter is routinely used after Aquablation. Many patients can have it removed within roughly one to two days, but longer catheterisation may be needed after treatment of a large gland, significant bleeding or preoperative retention.

Potential benefits

• Strong symptom and flow improvement.
• Non-thermal robotic tissue ablation with ultrasound planning.
• Can address median-lobe obstruction.
• Lower ejaculatory dysfunction rates than TURP in randomised evidence.
• Durable five-year data are available for moderate and large prostates.

Important limitations

• Requires an operating theatre, anaesthesia and specialised equipment.
• Bleeding and postoperative haemostasis still matter.
• Catheterisation is expected.
• Long-term comparative durability against size-independent enucleation is less established than for HoLEP.

Recovery after treatment

Blood in the urine, burning, urgency and frequency are expected early after surgery. Hydration and activity restrictions are similar to other transurethral prostate operations. Light activity is usually resumed relatively soon, while heavy lifting, strenuous gym work and cycling are delayed until bleeding has settled.

Urinary symptoms improve as postoperative swelling resolves. Some storage symptoms may persist temporarily if the bladder was overactive before surgery.

Erections and ejaculation

Aquablation has one of the more favourable ejaculation-preservation profiles among tissue-removing BPH operations. EAU guideline reviews report high rates of preserved antegrade ejaculation in long-term trial cohorts. Erectile function is generally maintained. Preservation is not guaranteed, and the final risk depends on the treatment plan and individual anatomy.

Risks and side effects

• Bleeding requiring irrigation, longer catheterisation, transfusion or further haemostasis in a minority of patients.
• Temporary burning, urgency, frequency or blood in the urine.
• Urinary infection.
• Temporary retention after catheter removal.
• Urethral or bladder-neck scar formation.
• Temporary urinary leakage; persistent incontinence is uncommon.
• Need for future prostate treatment if obstruction recurs.

What to bring for consultation

• Ultrasound report showing prostate volume and post-void residual urine.
• Uroflowmetry result if available.
• Urine routine/culture and serum creatinine.
• PSA report when it has been advised as part of your prostate assessment.
• A list of prostate medicines, blood thinners and other regular medicines.
• Records of previous retention, catheterisation or prostate/urethral procedures.

FAQs

Related reading

• Aquablation vs TURP: Which Is Better?
• Aquablation vs HoLEP: Which Is Better?
• Which Prostate Treatments Can Preserve Ejaculation?
• Which Prostate Surgery Is Best for Me? TURP, HoLEP or Other Options
• Ultrasound for Enlarged Prostate: Prostate Size, Bladder and Residual Urine
• Is Prostate Enlargement Cancer? BPH vs Prostate Cancer Explained
• Minimally Invasive Treatments for Enlarged Prostate
• Urologist in Latur

References

• European Association of Urology. EAU Guidelines on the Management of Non-neurogenic Male LUTS: Disease Management, 2026 https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts/chapter/disease-management
• American Urological Association. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia Guideline https://www.auanet.org/guidelines-and-quality/guidelines/bph-guideline
• National Institute for Health and Care Excellence. Transurethral water-jet ablation for lower urinary tract symptoms caused by BPH (HTG691) https://www.nice.org.uk/guidance/htg691
• British Association of Urological Surgeons. Prostate procedures: patient information https://www.baus.org.uk/patients/information_leaflets/category/8/prostate_procedures