Aquablation Therapy

Aquablation therapy is a minimally invasive surgical treatment for benign prostatic hyperplasia (BPH), also known as an enlarged prostate. The procedure uses real-time imaging and a robotically controlled, heat-free waterjet to precisely remove prostate tissue that is blocking urine flow.

Aquablation does not require external cuts or stitches. Instead, the surgeon accesses the prostate through the urethra, the tube that carries urine out of the body. Before removing tissue, the urologist uses ultrasound imaging and a small camera to map the prostate and create a treatment plan based on the patient’s anatomy. The robotic system then delivers the waterjet according to that plan while the surgeon remains in control. Aquablation typically takes about one hour.

Aquablation may be an option for men whose BPH symptoms affect their daily lives or have not improved enough with medication. A urologist can evaluate symptoms, prostate anatomy, overall health and treatment goals to determine whether Aquablation is appropriate.

What Is Aquablation Therapy, and How Does It Work?

Aquablation therapy is a minimally invasive surgical treatment designed to relieve lower urinary tract symptoms caused by BPH. As the prostate enlarges, it can press against the urethra and interfere with urine flow.

During Aquablation, a high-pressure, heat-free waterjet removes enlarged prostate tissue responsible for the blockage. The procedure combines ultrasound imaging, a small camera and robotic technology to help the surgeon plan and precisely guide treatment.

Because Aquablation does not use heat to remove prostate tissue, it provides another surgical option for men seeking relief from BPH symptoms while considering the potential effects of treatment on urinary and sexual function.

What is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia is the noncancerous enlargement of the prostate gland. As the prostate becomes larger, it can press against the urethra and restrict urine flow from the bladder.

BPH may cause:

• Frequent urination
• An urgent need to urinate
• A weak or slow urine stream
• Difficulty starting urination
• Difficulty completely emptying the bladder
• Waking frequently during the night to urinate

Treatment depends on how bothersome the symptoms are and how they affect a person’s health and quality of life. Medications are often used first. A surgical treatment may be considered when medication does not provide enough relief, symptoms continue to worsen or complications develop.

Who May Be a Candidate for Aquablation?

Aquablation may be considered for men with bothersome urinary symptoms caused by an enlarged prostate, particularly when symptoms persist despite medication or when a surgical treatment is appropriate.

Symptoms that may lead someone to seek BPH treatment include urinary frequency or urgency, weak urine flow, waking frequently at night to urinate and difficulty completely emptying the bladder.

Aquablation can be used to treat a wide range of prostate sizes. However, prostate size is only one factor a urologist considers when determining whether Aquablation is appropriate.

A consultation with a urologist is important because BPH treatment should be individualized based on symptoms, prostate anatomy, medical history, overall health and personal treatment goals.

Is Aquablation an Incisionless Procedure?

Yes. Aquablation does not require external incisions or stitches. The surgeon reaches the prostate by inserting specialized instruments through the urethra.

How Should I Prepare for Aquablation Therapy?

Before Aquablation, the care team will provide instructions based on the patient’s health history and medications. Preparation may include:

• Completing blood, urine or imaging tests
• Discussing prescription medications, over-the-counter medicines and supplements
• Following instructions about whether to temporarily stop blood-thinning medications
• Avoiding food and drinks for a specified period before the procedure
• Arranging transportation home after discharge

Your care team will provide specific instructions before your procedure. Do not stop taking medications unless instructed to do so by your health care provider.

What Happens During the Aquablation Procedure?

Aquablation combines real-time imaging, physician-directed planning and robotic technology to remove obstructive prostate tissue. The procedure generally includes two main steps:

• Creating a personalized treatment plan: The surgeon inserts a small camera through the urethra and uses ultrasound imaging to view the prostate. The physician identifies the tissue causing the blockage and creates a treatment map based on the patient’s anatomy.
• Removing the obstructive prostate tissue: Once the plan is established, a robotically controlled, heat-free waterjet follows the physician-created map to remove the targeted prostate tissue.

Removing this tissue opens the urinary channel and helps improve urine flow. The imaging and treatment map also help the physician identify and avoid areas that are important to urinary and sexual function.

Aquablation is performed under anesthesia and generally takes about one hour, although the length of the procedure may vary.

Is Aquablation Robotic Surgery?

Aquablation uses robotic-assisted technology, but the physician plans and oversees the treatment.

Using camera and ultrasound images, the urologist identifies the prostate tissue that should be removed and creates a customized surgical map. The robotic system then controls the waterjet according to the physician-created plan. The technology assists with precision and consistency, but it does not make treatment decisions independently.

Does Aquablation Use Heat or a Laser?

No. Aquablation does not use a laser or thermal energy to remove prostate tissue. It uses a high-pressure, heat-free waterjet.

During the procedure, the care team may use cautery after the waterjet treatment to control bleeding. This is different from using heat as the primary method of removing the prostate tissue.

What Can I Expect After Aquablation Therapy?

After the procedure, patients are monitored as they recover from anesthesia. Some patients go home the same day, while others stay in the hospital overnight. The discharge plan depends on the patient’s recovery and the physician’s recommendation.

A temporary urinary catheter is commonly used after Aquablation. The catheter drains urine and supports healing of the urinary tract. In many cases, it can be removed before the patient leaves the hospital, although some patients may need a catheter at home for several days.

Before discharge, the care team will provide instructions about:

• Catheter care, if needed
• Prescribed medications
• Hydration
• Physical activity and lifting restrictions
• Returning to work, exercise and sexual activity
• Symptoms that require medical attention
• Follow-up appointments

How Long Does It Take to Recover From Aquablation?

Recovery varies based on the patient’s health, prostate size and individual procedure. Temporary urinary symptoms, such as mild burning, urgency, frequency or blood in the urine, may occur as the urinary tract heals.

Patients should avoid strenuous activity until cleared by their urologist. The care team will provide individualized guidance about returning to work, exercise and other normal activities.

What Are the Potential Benefits of Aquablation Therapy?

Aquablation is designed to provide meaningful, lasting relief from urinary symptoms caused by BPH.

Potential benefits may include:

• Improved urine flow
• Reduced urinary frequency and urgency
• Less difficulty starting urination
• Improved bladder emptying
• Fewer nighttime trips to the bathroom
• Treatment customized to the patient’s prostate anatomy
• Heat-free removal of obstructive prostate tissue
• No external incisions or stitches
• Treatment for a range of prostate sizes
• A lower risk of certain sexual side effects compared with some traditional BPH procedures

Aquablation’s imaging-guided approach allows the surgeon to map the prostate and target the tissue causing the obstruction. This precision can help protect nearby structures involved in continence and sexual function. However, individual outcomes vary, and preservation of sexual or urinary function cannot be guaranteed.

What Are the Risks of Aquablation?

As with any medical or surgical procedure, Aquablation has potential risks and complications.

These may include:

• Bleeding or blood in the urine
• Urinary tract infection
• Temporary pain or burning during urination
• Difficulty urinating
• The need for a urinary catheter
• Urinary incontinence
• Changes in ejaculation
• Erectile dysfunction
• The need for additional treatment
• Risks associated with anesthesia

Individual risks vary based on a patient’s health, prostate anatomy and other factors. Your urologist can explain the potential risks and benefits and help determine whether Aquablation is appropriate for you.