Where is Aquablation available in London?
Mr Torath Ameen is one of a small number of consultants in the London and Hertfordshire region offering Aquablation at multiple sites — both privately and on the NHS.
The Wellington Hospital
Wellington Place, St John's Wood, London NW8 9LE
Same-day investigations available. Central London access.
Spire Bushey Hospital
Heathbourne Road, Bushey, Hertfordshire WD23 1RD
Flexible appointment times. Hertfordshire and North London access.
West Hertfordshire Teaching Hospitals
NHS availability subject to referral and eligibility criteria. Ask your GP about a urology referral to Mr Ameen's NHS list.
What is Aquablation?
Aquablation therapy (using the Aquabeam or the newer HYDROS robotic system) is a minimally invasive surgical treatment for benign prostatic hyperplasia (BPH) — an enlarged prostate causing troublesome urinary symptoms. It combines live 3D ultrasound imaging with a robotically delivered high-pressure waterjet that ablates prostate tissue according to a pre-planned, patient-specific map.
Unlike TURP, where the surgeon manually removes tissue based on endoscopic vision alone, or laser procedures that similarly rely on the operating surgeon's direct visualisation, the Aquabeam robot executes the resection plan autonomously — while the surgeon monitors the prostate in real time via live ultrasound. The tissue being removed, and the tissue being preserved, are visible throughout. This is the key clinical advantage that makes Aquablation more precise than any manually executed BPH procedure.
Why live ultrasound guidance matters
The defining feature of Aquablation — and the reason Mr Ameen regards it as the most accurate BPH procedure available — is that the surgeon sees the prostate in real time throughout the resection, not just during planning.
How Aquablation's live ultrasound changes what's possible
Clinical evidence and guideline status
Aquablation has a stronger evidence base than most newer BPH procedures — it has been through multiple randomised controlled trials rather than relying on observational data alone.
The WATER trial (randomised vs TURP in prostates 30–80 ml) demonstrated equivalent symptom improvement with superior ejaculatory function preservation. The WATER II trial extended this to large prostates (80–150 ml) — where TURP is technically demanding — with durable 5-year results. The WATER III trial is comparing Aquablation directly to laser enucleation (HoLEP) in large glands.
In March 2026, the European Association of Urology upgraded Aquablation to a strong recommendation as a surgical alternative to TURP for moderate-to-severe BPH — with specific recognition for its sexual function preservation profile. This is the highest guideline endorsement category for a BPH procedure.
Who is a candidate for Aquablation?
Aquablation is appropriate for men with:
- Moderate to severe lower urinary tract symptoms (IPSS score ≥ 8) due to BPH
- Symptoms not adequately controlled by medication (tablet treatments for an enlarged prostate)
- Prostate volume between 30 ml and 150 ml — particularly valuable for prostates over 80 ml where TURP is less reliable
- A wish to preserve ejaculatory function — Aquablation has the best sexual function profile of any surgical BPH treatment
- Fitness for general or spinal anaesthetic
- No suspicion of prostate cancer — cancer must be excluded before any BPH procedure
Aquablation can also treat prostates with a median lobe (a tongue of tissue projecting into the bladder) — unlike Urolift. This versatility, combined with its size range, makes it suitable for a broader range of patients than most alternatives.
How Aquablation is performed
Recovery after Aquablation
| Timeframe | What to expect |
|---|---|
| Day 1–2 | Catheter removed once voiding confirmed. Discharge home. Some blood-staining of urine normal for up to 2 weeks. |
| Week 1–2 | Rest at home. Avoid strenuous activity, cycling and heavy lifting. Drink plenty of water. Urgency and frequency may temporarily increase before improving. |
| Week 2–4 | Return to normal daily activities including driving. Urine flow typically noticeably improved. |
| Month 1–3 | Progressive symptom improvement. IPSS scores typically fall by 50–70%. Temporary urgency usually resolves. |
| Month 3–6 | Full benefit established. Outpatient review with flow rate assessment. Most men satisfied at this stage. |
| Year 1–5 | WATER and WATER II trials confirm durable improvement to 5 years with low retreatment rates. |
Risks and side effects
Common (10–20%)
Post-operative bleeding
The most significant complication specific to Aquablation. Blood in the urine after catheter removal is expected; in some cases a return to theatre or transfusion may be needed. Skilled haemostasis at the end of the procedure reduces this risk considerably.
Common (temporary)
Urgency and frequency
Irritative urinary symptoms often worsen before improving in the first 4–6 weeks as the prostate cavity heals. These typically resolve fully.
Lowest of any surgical BPH treatment
Retrograde ejaculation
Aquablation's planned avoidance of the ejaculatory ducts — executed robotically rather than by eye — gives it the lowest retrograde ejaculation rate of any surgical BPH procedure. In the WATER trial, rates were significantly lower than with TURP.
Uncommon
Urinary tract infection
Prophylactic antibiotics are given. UTI in the early post-operative period is treated with oral antibiotics.
Uncommon (<5%)
Urinary retention
Difficulty passing urine after catheter removal. Usually resolves with a short period of recatheterisation. More common in men with very large prostates or poor pre-operative bladder function.
Rare
Urethral stricture
Scarring of the urethra, occurring less frequently than with TURP. Treated endoscopically if it develops.
Aquablation vs other BPH treatments
Aquablation is Mr Ameen's preferred surgical treatment for an enlarged prostate, particularly for men who wish to preserve sexual function or who have a larger prostate gland. The table below compares it to the main alternatives.
| Factor | Aquablation | TURP | Rezum | Laser (HoLEP/ThuLEP) |
|---|---|---|---|---|
| Prostate size range | 30–150 ml | Up to ~80 ml | 30–80 ml | Any size |
| Live ultrasound guidance | Yes — throughout | No | No | No |
| Robotic execution | Yes — fully robotic | Manual | Manual | Manual |
| Ejaculatory function | Best preserved of any surgical option | Retrograde ejac. ~65% | Low risk | High retrograde ejac. risk |
| Erectile function | Not affected | Risk ~10% | Not affected | Low risk |
| Median lobe treatment | Yes | Yes | Limited | Yes |
| Anaesthetic required | General or spinal | General or spinal | Local/sedation | General or spinal |
| Hospital stay | 1–2 nights | 1–3 nights | Day case | 1–2 nights |
| IPSS improvement | 50–70% | 60–70% | 40–60% | 60–70% |
| EAU/NICE status | Strong rec. (EAU 2026) | Gold standard | Approved | Approved |
| Available at | Wellington, Spire Bushey (private); West Herts (NHS) | Multiple centres | Wellington, Harley St | Specialist centres |
Frequently asked questions
Mr Torath Ameen offers Aquablation privately at the Wellington Hospital in St John's Wood, London, and at Spire Bushey Hospital in Hertfordshire. He also performs Aquablation on the NHS at West Hertfordshire Teaching Hospitals. Private consultations can be arranged within days — contact Belinda on 0204 558 6750, pa@prostatesurgery.co.uk, or via WhatsApp on 07768 648628.
Aquablation is guided by live 3D ultrasound throughout the procedure — the surgeon sees the prostate in real time as the robotic waterjet removes tissue. TURP relies on the surgeon's visual judgement through the endoscope without live tissue imaging. Laser procedures similarly depend on the operating surgeon's direct visualisation. The combination of individual pre-planned resection, robotic execution, and live ultrasound confirmation makes Aquablation the most precisely controlled BPH surgical technique currently available.
Yes. NICE supports the routine use of Aquablation within the NHS (MIB315). Mr Ameen performs Aquablation on the NHS at West Hertfordshire Teaching Hospitals. Eligibility depends on your symptoms, prostate size and local referral pathways — ask your GP about a urology referral. Privately, Aquablation can typically be arranged within 2–4 weeks at the Wellington Hospital or Spire Bushey, with an initial consultation available within days.
Aquablation has the best-preserved sexual function profile of any surgical BPH treatment. The pre-planned resection specifically avoids the ejaculatory ducts — and because the resection is executed robotically to that plan rather than manually by eye, this protection is reliable and consistent. In the WATER trial, retrograde ejaculation rates with Aquablation were significantly lower than with TURP. Erectile function is not typically affected by Aquablation.
Aquablation is effective for prostates from 30 ml to 150 ml — a broader range than most BPH procedures. TURP becomes increasingly difficult above 80 ml, and Rezum is less reliable above that size. Aquablation's robotic execution means resection time is under 4 minutes regardless of prostate size, making it particularly valuable for men with larger glands.
Both are effective surgical treatments for enlarged prostates. Laser enucleation (HoLEP and ThuLEP) removes the prostate's inner zone in its entirety using a laser — highly effective but with a higher rate of retrograde ejaculation than Aquablation, and dependent entirely on the surgeon's manual skill and experience. Aquablation removes planned tissue with a robotic waterjet guided by live ultrasound, making it more reproducible and offering better sexual function preservation. The WATER III trial is comparing the two techniques directly in large prostates.