What is Aquablation?
Aquablation therapy (using the Aquabeam robotic system) is a minimally invasive surgical treatment for benign prostatic hyperplasia (BPH) — an enlarged prostate causing troublesome urinary symptoms. It combines real-time 3D ultrasound imaging with a robotically delivered high-pressure waterjet that ablates prostate tissue according to a pre-planned map.
Unlike traditional endoscopic procedures where the surgeon manually removes tissue using electrical energy, the Aquabeam robot executes the resection plan autonomously and consistently — removing exactly the tissue planned, in under four minutes, regardless of prostate size. This precision reduces the risk to the ejaculatory ducts, which is why Aquablation has the lowest rates of retrograde ejaculation of any surgical BPH treatment.
Clinical evidence and guideline status
Aquablation is backed by a strong and growing body of clinical trial evidence — more than most newer BPH procedures.
The WATER trial (randomised controlled trial vs TURP in prostates 30–80 ml) demonstrated equivalent symptom improvement and superior ejaculatory function preservation. The WATER II trial extended this to large prostates (80–150 ml) — a population where TURP is technically demanding — with durable 5-year results. The WATER III trial is comparing Aquablation to laser enucleation in large glands.
In March 2026, the European Association of Urology upgraded Aquablation to a strong recommendation as a surgical alternative to TURP for men with moderate-to-severe BPH symptoms, with specific recognition for patients wishing to preserve ejaculatory function.
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 (alpha-blockers, 5-alpha reductase inhibitors)
- Prostate volume between 30 ml and 150 ml — Aquablation is particularly valuable for prostates over 80 ml
- A wish to preserve ejaculatory function (including antegrade ejaculation)
- Fitness for general or spinal anaesthetic
- No suspicion of prostate cancer (prostate cancer is ruled out before BPH surgery)
It is generally not used for prostates under 30 ml, where less invasive options (Rezum, Urolift) may be equally effective with less intervention. Mr Ameen will assess your prostate volume via ultrasound and urine flow studies at your consultation to confirm suitability.
How Aquablation is performed — step by step
Recovery after Aquablation
| Timeframe | What to expect |
|---|---|
| Day 1–2 | Catheter removed once comfortable voiding is confirmed. Discharge home. Some blood-staining of urine is normal for up to 2 weeks. |
| Week 1–2 | Rest at home. Avoid strenuous activity, cycling, or heavy lifting. Drink plenty of water. Urgency and frequency may temporarily worsen before improving. |
| Week 2–4 | Most patients return to normal daily activities including driving. Flow typically noticeably improved. |
| Month 1–3 | Continued improvement in urinary symptoms. IPSS scores typically fall by 50–70%. Temporary urinary urgency usually resolves. |
| Month 3–6 | Full benefit of the procedure established. Outpatient review with urine flow assessment. Most men satisfied at this stage. |
| Year 1–5 | WATER and WATER II trials confirm durable improvement to 5 years. Retreatment rates with Aquablation are low. |
Risks and side effects
Common (10–20%)
Post-operative bleeding
The most significant complication unique to Aquablation. Blood in the urine after catheter removal is expected, but in some cases a return to theatre or blood transfusion may be needed. Skilled haemostasis reduces this risk considerably.
Common (temporary)
Urgency and frequency
Irritative urinary symptoms often worsen before improving in the first 4–6 weeks. This is due to healing within the prostate cavity and usually resolves fully.
Less common than TURP
Retrograde ejaculation
Aquablation has the lowest rates of retrograde ejaculation of any surgical BPH treatment due to targeted protection of the ejaculatory ducts. In the WATER trial, rates were significantly lower than with TURP.
Uncommon
Urinary tract infection
Prophylactic antibiotics are given. UTI can occur in the early post-operative period and is treated with 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 occurs less frequently than with TURP. If it develops, it is treated endoscopically.
Aquablation vs other BPH treatments
| Factor | Aquablation | TURP | Rezum | Urolift |
|---|---|---|---|---|
| Prostate size range | 30–150 ml | Up to ~80 ml | Up to ~80 ml | 30–80 ml (no median lobe) |
| Robotic execution | Yes — fully robotic resection | Surgeon-manual | Surgeon-manual | Surgeon-manual |
| Ejaculatory function | Best preserved | Retrograde ejaculation ~65% | Low risk | Preserved |
| Erectile function | Not affected | Risk ~10% | Not affected | Not affected |
| Anaesthetic needed | General or spinal | General or spinal | Local/sedation | Local/sedation |
| Hospital stay | 1–2 nights | 1–3 nights | Day case | Day case |
| Symptom improvement | 50–70% IPSS reduction | 60–70% | 40–60% | 30–50% |
| 5-year evidence | WATER I + II trials | Decades of data | 5-yr data available | 5-yr data available |
| Bleeding risk | Higher than Rezum/Urolift | Moderate | Very low | Very low |
| NICE/EAU status | Strong recommendation (EAU 2026) | Gold standard | NICE-approved | NICE-approved |
Frequently asked questions
Yes. NICE supports the routine use of Aquablation within the NHS (MIB315). Access depends on local commissioning decisions and whether your NHS trust has the Aquabeam system. Ask your GP whether it is available at your local trust. Privately, Aquablation is available in London with short waiting times.
HoLEP (holmium laser enucleation of the prostate) removes the prostate's inner tissue in its entirety and is particularly effective for large glands. It has a longer and more demanding learning curve than Aquablation. The WATER III trial is currently comparing Aquablation to laser enucleation in large prostates — early results suggest equivalent outcomes with potentially better sexual function preservation with Aquablation. Both are valid options and your surgeon's experience with each technique is an important factor.
Yes — a urinary catheter is inserted at the end of the operation and left in overnight. It is typically removed the following morning (24–48 hours post-operatively), once you can pass urine comfortably without it. This is much shorter than the 7–10 days required after robotic prostatectomy. Some blood-staining of urine for the first 1–2 weeks after catheter removal is normal.
Yes — unlike Urolift, Aquablation can treat prostates with a median lobe (a tongue of prostate tissue that projects into the bladder). The 3D ultrasound mapping allows the surgeon to include the median lobe in the resection plan. This is one of Aquablation's advantages over some other minimally invasive treatments.
Retreatment rates after Aquablation are low — the 5-year WATER II data shows durable results. If symptoms do return, further treatment options are available including repeat Aquablation, Rezum, or TURP. Because Aquablation does not affect the anatomy in a way that complicates further surgery, retreatment options remain straightforward.