Aquablation is a treatment for benign prostatic hyperplasia (BPH) — an enlarged prostate. This procedure combines ultrasound imaging and a high-pressure water jet to find and remove excess prostate tissue.

What is Aquablation?

Aquablation is the trademarked name for a treatment of BPH. Approved by the Food and Drug Administration, this minimally invasive procedure uses a robotically guided camera and ultrasound imaging to map the prostate. The individualized map is used to guide a high-pressure, heat-free water jet to destroy and remove excess prostate tissue.

Who may need Aquablation?

Aquablation can be performed on prostates of any size. It is suitable for people with BPH symptoms, including:

• Urinary urgency and frequency
• Slower urinary stream
• Waking up frequently at night to urinate
• The sensation of an incomplete emptying of the bladder

How does Aquablation work?

The process has two steps that happen one after the other while you are asleep under general anesthesia.

First, a robotic imaging machine creates a surgical map that is customized to your anatomy. A tiny camera, inserted into the body with a tube (cytoscope), is used in combination with ultrasound imaging.

The two types of imaging used together give the surgeons a clear picture of what prostate tissue needs to be removed. This precise guidance helps spare structures in the urinary tract and lowers the risk of complications such as ejaculation problems.

The second step is use of a robotically controlled heat-free water jet that follows the surgical map precisely and removes only the prostate tissue that needs to come out.

The software is integrated so that the surgeon can create a treatment plan and then use the robotic device to perform the resection precisely according to that plan.

Aquablation Recovery

The patient wakes up in the recovery room with a catheter that will both drain the urine and rinse the inside of the bladder to clear away bleeding. After Aquablation, most people stay for two or three hours in the recovery room, where they are monitored as they wake up from the anesthesia.

The catheter stays in place until the doctor decides the urine is clear enough of blood and debris. Some people spend a night in the hospital. Others are discharged the same day once they have recovered from the anesthesia. 

A medicine may be used to reduce burning sensation.

Patients who goes home with a catheter will have instructions how to deal with the catheter, including how to flush it to remove blockages and when and how to empty the bag.

Benefits of Aquablation

Aquablation is a minimally invasive, robotically performed procedure that uses a heat-free, high-power water jet. There is no incision, and recovery lasts no longer than after traditional surgery.

Although Aquablation treatment is relatively new, the results are encouraging. One small study of 113 patients, published in October 2023, concludes that Aquablation is an effective method for treatment of men with urinary retention, noting that 98% of the subjects in the study were able to urinate spontaneously after the treatment.

Aquablation Versus TURP

Aquablation may be an effective and safer alternative to transurethral resection of the prostate (TURP). In a trial in which patients received either Aquablation or TURP, urine flow and BPH symptom reduction were comparable between the two groups, and Aquablation had fewer side effects than TURP, especially regarding preserving the ability to ejaculate.

Aquablation Side Effects

Patients must be sure to follow all instructions provided by their care team and contact the team if side effects seem unexpected. The following are common side effects of Aquablation.

• Blood in urine: Blood will be seen in the urine for several weeks. The blood is most obvious at the start of urination and may clear as the stream continues. It is very important to drink lots of fluids to help flush blood out of the urinary tract.
• Difficulty urinating: It may be difficult to urinate at first because the area surrounding the urethra will be swollen. As swelling goes down, it will become easier to urinate week by week.
• Urinary urgency: Sudden, strong urges to urinate may occur while the bladder muscles adjust to the absence of the extra prostate tissue that held the urinary sphincter closed. The muscles controlling the urinary sphincter will strengthen over time.
• Changes in sexual response: Once the urine is clear and it has been at least two weeks since the Aquablation, it is safe to return to sexual activity. Orgasm and ejaculation are not affected in most people after the procedure, but there may be a temporary or persistent absence of ejaculation or a decline in the volume of semen. 

Aquablation Complications

Bleeding is a common side effect, but it should improve over time, so the patient must be sure to call the doctor if it seems to be getting worse. The risk of bleeding is higher for large prostates (more than 80 g).

Aquablation complications are rare, but the doctor must be called immediately if the patient:

• Has pain or burning that becomes worse
• Sees blood clots
• Cannot empty the bladder
• Feels dizzy or weak
• Has a fever of 101 or higher