Aquablation
Aquablation removes the overgrown inner prostate with a high-speed jet of salt water. The surgeon maps the area to treat on live ultrasound, and a robot then guides the waterjet precisely through a scope in the urethra.
Also called Aquablation, Aquablation therapy, AquaBeam, robotic waterjet prostate surgery, waterjet ablation of the prostate, image-guided robotic waterjet ablation, water jet prostate, heat-free prostate surgery
- Where
- Hospital operating room
- Anesthesia
- General anesthesia (asleep) or a spinal
- Time in the room
- About 1 hour in the operating room; the waterjet itself works for only a few minutes
- Hospital stay
- Usually one night
- Going home with
- Catheter for about 1 to 3 days
- Back to normal
- About 2 weeks for light activity, about 4 to 6 weeks for everything
- Back to work
- Desk work in about 1 to 2 weeks; heavy work in about 4 to 6 weeks
Overview
In BPH (benign prostatic hyperplasia), the inner prostate grows and squeezes the urethra, the tube that carries urine out. Aquablation removes that inner growth using a thin, very fast stream of salt water instead of heat or electricity.
The surgeon places an ultrasound probe in the rectum and a scope in the urethra. On the ultrasound images, the surgeon draws the exact area to remove and marks the areas to avoid, especially near the verumontanum, a small bump where semen enters the urethra. A robot then moves the waterjet back and forth to remove the planned tissue. The surgeon watches the whole time and can stop it at any point.
The AUA guideline lists Aquablation as an option for prostates about 30 to 150 grams. In the WATER trial, which compared it with TURP for prostates 30 to 80 grams, symptom improvement was similar, and fewer men lost ejaculation. The WATER II study showed it also works for larger prostates, 80 to 150 grams.
Because the waterjet does not seal blood vessels as it cuts, bleeding has to be controlled afterward, either with light cautery at the bladder neck or by pulling the catheter balloon snug against the prostate. Most men stay one night.
The parts of your body involved
The prostate sits below the bladder and wraps around the urethra. In BPH, the side lobes grow inward and a middle lobe may grow up into the bladder. The ejaculatory ducts, which carry semen, enter the urethra at the verumontanum near the bottom of the prostate. The tissue just above it plays a part in ejaculation, which is why Aquablation is planned to leave that area alone.
- Side and middle lobes
The overgrown inner prostate, which the waterjet removes.
- Verumontanum
The small bump where semen enters. The plan avoids it.
- Bladder neck
The bladder's outlet, which also closes during orgasm.
- Rectum
Lies just behind the prostate. The ultrasound probe sits here to give a live picture.
- External sphincter
The muscle below the prostate that keeps you dry. It is outside the treatment zone.
Why it’s done
Aquablation is offered to men with bothersome symptoms or blockage from BPH who want results close to TURP with a better chance of keeping ejaculation, including men with larger prostates.
- Bothersome symptoms
Weak stream, straining, frequency, or night-time urination despite medicines.
- Protecting ejaculation
Planned to leave the tissue that matters for ejaculation alone.
- Larger prostates
Works for prostates up to about 150 grams, a range where many other options do not fit well.
- Middle lobe
Can remove a middle lobe.
- Retention or complications
Inability to empty, stones, infections, or bleeding from BPH.
Other options
- Watching and waiting or medicines
Lifestyle changes, alpha blockers, 5-alpha reductase inhibitors, or tadalafil.
- TURP
The long-standing standard for 30 to 80 gram prostates, with similar improvement but a higher chance of dry orgasm.
- HoLEP
Removes the whole inner growth with a laser; any size; very durable; most men have dry orgasms.
- Rezum or UroLift
Office options that protect ejaculation well, with smaller improvement.
- Simple prostatectomy
For very large prostates, through the belly.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks before
The week before
The day before
The morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Anesthesia
You are put to sleep or given a spinal. Monitors watch your heart and breathing.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
In the hospital
- Recovery room
You wake with a catheter and rinse running.
- Traction
If the catheter is pulled snug, it is released after several hours. You may feel pressure until then.
- Bladder spasms
Common and treated with medicine.
- Overnight
Most men stay one night while the urine clears.
- Catheter removal
Usually the next day or within a few days, followed by a check that you can empty.
At home
- Pain
Usually mild; acetaminophen often enough.
- Blood in the urine
Pink urine on and off for several weeks, sometimes with a flare at 2 to 3 weeks.
- Burning and urgency
Common for a few weeks.
- Drinking
Aim for about 6 to 8 glasses of water a day unless told otherwise.
- Bowels
Avoid straining. Use a stool softener.
- Activity and lifting
Walk daily. Avoid lifting over about 10 to 15 pounds (5 to 7 kg), hard exercise, and cycling for about 4 weeks.
- Driving
Not with a catheter or while taking opioids.
- Sex
Usually after about 3 to 4 weeks.
Recovery timeline
- Day 0Surgery
Catheter and bladder rinse overnight.
- Days 1 to 3Catheter out
You go home and urinate on your own.
- Week 1Healing
Burning, frequency, and some blood.
- Weeks 2 to 3Possible bleeding flare
Drink more and rest.
- Weeks 4 to 6Full activity
Back to lifting, exercise, and cycling.
- 3 monthsFollow-up
Symptoms, flow, and emptying are checked.
- Long termDurability
In the WATER trial, improvement lasted through 5 years for most men.
What it feels like
Men describe recovery as similar to TURP in the first weeks, with a catheter, burning, and some blood. What many value is that ejaculation is more often kept.
Before surgery
Curiosity or worry about a robot and a waterjet.
What helpsAsk your surgeon to show you the planning screen and explain the safety stops.
Waking up
Pressure from the catheter, especially if it is on traction, and bladder spasms.
What helpsSpasm medicine. The traction is usually released within hours.
The first night
Watching the urine bag for color changes.
What helpsNurses adjust the rinse to keep it light pink.
The first weeks
Burning and frequent trips, sometimes a scare from a bleeding flare.
What helpsDrink more, rest, and call if clots block the flow.
Intimacy
Relief for many men that ejaculation continues.
What helpsKnow it is more likely kept, though not guaranteed.
How well it works
Aquablation gives improvement close to TURP, with a better chance of keeping ejaculation.
- Symptoms and flow
In the WATER trial, symptom scores improved by about half or more, similar to TURP.
- Ejaculation
In WATER, about 1 in 10 men lost ejaculation after Aquablation, compared with about 1 in 3 after TURP.
- Durability
About 4 in 100 men needed another procedure for BPH within 5 years in WATER.
- Large prostates
The WATER II study showed similar improvement in prostates 80 to 150 grams.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
On and off for several weeks.
For a few weeks.
Less likely than with TURP or HoLEP but still possible.
Less common
Uncommon. More likely with very large prostates.
Treated with antibiotics.
May need a catheter for a few more days.
For regrowth or tissue left behind.
Rare
Rare, since the continence muscle is outside the plan.
At the bladder neck or in the urethra.
Very rare.
As with any anesthesia and surgery.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- No urine draining from your catheter for 1 hour
- Not able to urinate for 6 hours, or a painful, full lower belly
- Thick dark red urine or clots that block the flow
- Feeling faint or dizzy with heavy bleeding
- Pain, swelling, or warmth in one leg
- Chest pain or sudden shortness of breath (call 911)
Questions to ask your surgeon
- Is my prostate a good size and shape for Aquablation?
- How many Aquablation procedures have you done?
- How will you control bleeding, and how long will I have a catheter?
- What are my chances of keeping ejaculation?
- Do I need to stop my blood thinner?
- Will I stay overnight?
- Will any tissue be sent to the lab?
- How does this compare with HoLEP for someone with my prostate?
Words you may hear
- Aquablation
- Removing prostate tissue with a robot-guided waterjet.
- TRUS
- Transrectal ultrasound: an ultrasound probe in the rectum that shows the prostate.
- Handpiece
- The scope and waterjet nozzle placed in the urethra.
- Verumontanum
- A small bump where semen enters the urethra; avoided to protect ejaculation.
- Traction
- Pulling the catheter balloon snug against the bladder neck to slow bleeding.
- Cautery
- Using electric current to seal bleeding vessels.
- BPH
- Benign prostatic hyperplasia: non-cancer growth of the prostate.
- Continuous bladder irrigation
- Salt water flowing in and out through a catheter to prevent clots.
- Retrograde ejaculation
- Semen going into the bladder instead of out during orgasm.
Common questions
Is the robot doing the surgery?
The surgeon plans the treatment and watches the whole time. The robot moves the waterjet to follow that plan and can be stopped instantly.
Why does it protect ejaculation better?
The plan avoids the tissue around the verumontanum, where semen enters.
Is there more bleeding than with laser surgery?
The waterjet does not seal vessels, so bleeding is controlled afterward. Serious bleeding is uncommon but is more likely with very large prostates.
Can it treat a large prostate?
Yes, up to about 150 grams per the AUA guideline.
Will it affect erections?
Studies have not shown a meaningful effect on erections for most men.
Sources this page draws on
- American Urological Association, Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline
- WATER study investigators (Gilling and colleagues), WATER randomized trial of Aquablation versus TURP and its 5-year results
- WATER II study investigators, WATER II study of Aquablation in prostates 80 to 150 grams
- European Association of Urology, EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms
- Urology Care Foundation, Benign Prostatic Hyperplasia (BPH)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.