Aquablation Therapy: A Surgical Innovation in BPH Treatment

The field of urology is witnessing transformative changes with the integration of Aquablation therapy in the management of benign prostatic hyperplasia (BPH). This innovative approach is redefining precision and, in clinical trials and selected patients, has been associated with shorter catheterization and hospital stays compared with some traditional techniques, supporting meaningful improvements in recovery for appropriately selected men.

Aquablation therapy uses a high‑velocity saline jet (hydrodissection) under real‑time transrectal ultrasound guidance with robotic control (AquaBeam), offering a precise, minimally invasive approach to BPH treatment. This approach effectively targets the clinical goal of removing obstructive tissue while limiting collateral damage, as reported by UAB Urology.

By enhancing surgical accuracy and supporting faster recovery for many patients, Aquablation represents a promising option alongside traditional methods, with the optimal choice depending on prostate size, anatomy, comorbidities, and individual goals.

Clinical trials reveal that Aquablation can preserve sexual function and avoid thermal injury to surrounding structures. In randomized trials such as WATER (predominantly 30–80 mL prostates), Aquablation preserved antegrade ejaculation in a substantially higher proportion of men than TURP across 3–12 months, while WATER II extended feasibility to larger glands with similar functional findings. Across early and mid‑term follow‑up, studies report higher rates of preserved ejaculation with Aquablation versus TURP and low urethral stricture rates, with randomized data (e.g., WATER) supporting these patterns over 3–12 months.

Taken together, these findings position Aquablation as a viable alternative to TURP and HoLEP, with particular advantages in preserving ejaculatory function, as discussed in comparative analyses of Aquablation and holmium laser enucleation of the prostate here.

In contemporary practice guidance, major urology guidelines (AUA and EAU) recognize Aquablation as an evidence‑supported option alongside TURP and laser enucleation, particularly for moderate-to-large prostates, while emphasizing that modality selection should reflect prostate size, anatomy, and patient priorities.

Adoption of aquablation therapy is gaining momentum at institutions such as UAB Urology, showcasing its integration into clinical practice, supported by U.S. regulatory clearance and expanding payer coverage that together facilitate broader access.

Patient selection remains central: median lobe configuration, prior procedures, anticoagulation status, and goals regarding ejaculatory function often guide whether Aquablation, TURP, or HoLEP is most appropriate. Shared decision‑making that integrates symptom burden (e.g., IPSS), prostate size on imaging, and tolerance for specific risks helps align therapy with outcomes that matter to patients.

Looking forward, advancements in imaging and robotic automation are enabling more patient‑tailored interventions within BPH care and related prostate surgery contexts, with Aquablation poised to benefit from this personalization trend. These trends align with the move toward minimally invasive, precision‑guided care.

Key Takeaways:

• Mechanism-to-outcome: Hydrodissection under ultrasound and robotic control aims to remove obstructive tissue while limiting collateral damage, supporting continence and sexual function preservation.
• Data-to-practice: RCTs (e.g., WATER) show higher rates of ejaculatory function preservation versus TURP over 3–12 months, informing counseling for sexually active patients.
• Comparative role: Aquablation is a viable alternative to TURP and HoLEP, with specific advantages in ejaculation preservation and low stricture rates in early to mid‑term follow‑up.
• Guideline placement: AUA/EAU acknowledge Aquablation among evidence‑supported options, with selection tailored to prostate size, anatomy, and patient priorities.
• Adoption context: Integration into U.S. practice is supported by regulatory clearance and growing coverage, improving access where clinically appropriate.
• Patient selection: Anatomy (e.g., median lobe), comorbidities, and the importance of preserving ejaculation inform choice among Aquablation, TURP, and HoLEP.