A new robotic treatment known as Aquablation therapy is transforming the way doctors treat men suffering from the effects of an enlarged prostate — a common condition that can make urination difficult and disrupt daily life.
A common problem, a new solution.
An enlarged prostate, also known as Benign Prostatic Hyperplasia (BPH), is one of the most common health issues in men over 50. It can cause frequent trips to the bathroom, a weak urine stream, and trouble fully emptying the bladder — symptoms that can greatly impact daily life.
Traditionally, surgery to remove the excess prostate tissue has involved heat or electrical current, which can lead to longer recovery times and, in some cases, side effects such as retrograde ejaculation (when semen travels backward into the bladder) or erectile difficulties.
What is Aquablation therapy?
Aquablation therapy is a contemporary minimally invasive surgical treatment for men suffering from lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH). The technique employs a high-velocity, heat free waterjet, guided by real-time imaging and robotic precision, to remove obstructive prostate tissue via the urethra.
Why consider Aquablation therapy?
There are some of potential advantages that have emerged from studies and clinical use:
- Symptom relief: Data show that Aquablation leads to significant improvements in urinary symptoms
- Durability: Medium to longer-term follow-up (up 5 years studies) indicates sustained symptom relief and relatively low rates of retreatment compared to standard surgery.
- Sexual function preservation: Data suggest better preservation of ejaculatory function compared to some traditional treatments (which often cause retrograde ejaculation) and comparable erectile function outcomes.
- Faster learning curve: Evidence indicates the procedure may be easier for surgeons to adopt relative to some more technically demanding techniques.
- Flexibility: Because of its heat-free nature and imaging guidance, it may be used for prostates with complex shapes or larger volumes that may be more challenging for other techniques.
How the procedure works?
- Under general or spinal anaesthesia, the surgeon uses a cystoscope and transrectal ultrasound imaging to map the prostate’s anatomy and identify obstructive tissue, whilst preserving delicate areas which protect continence and ejaculatory function.
- A robotic handpiece is introduced, and the heat free, high velocity waterjet is used to ablate the predefined tissue zones, removing the obstruction.
- The removed tissue may be aspirated and sent for histological analysis if needed.
- The surgeon ensures haemostasis (control of bleeding) using focal thermal energy
- The patient recovers with a catheter for a short period; typical hospital stay and recovery vary by centre and patient.
Who might benefit?
While individual patient suitability must be determined via consultation with a urologist, the following groups may particularly benefit:
- Men with moderate to severe LUTS due to BPH, especially when medication alone hasn’t provided adequate relief.
- Men with larger prostates (>50 mL) or complex anatomy who might not be ideal candidates for simpler minimally invasive treatments.
- Men who are concerned about preserving sexual (especially ejaculatory) function and want a procedure that is more “sexual-function friendly.”
- Patients looking for a potentially shorter recovery time and less risk of certain side-effects compared to older surgical techniques.
Considerations and caveats before proceeding
- As with any surgery, risks include bleeding, urinary tract infection, need for catheterization post-procedure, urinary urgency/frequency, incomplete relief, and retreatment.
- Recovery considerations: While some centres offer the procedure as day-case, many still involve an overnight hospital stay depending on local protocols and patient health and wish.
- Long-term data: While results up to 5 years are promising, longer-term outcomes (10+ years) are still being gathered.
- Alternative treatments: It’s worth comparing Aquablation with other options (e.g., TURP, HoLEP, UroLift, prostate artery embolization) in terms of efficacy, risks, recovery, sexual side-effects.
Aquablation therapy is rapidly establishing itself as a strong contender in the surgical management of BPH.
The future of prostate surgery?
Many specialists believe Aquablation represents a significant step forward in the surgical treatment of BPH. By combining imaging, robotics, and the precision of waterjet technology, it offers a modern solution to a centuries-old problem.
“It’s about improving quality of life,” says Mr Leye Ajayi, Consultant Urological surgeon. “Men shouldn’t have to put up with these symptoms, and now we have another effective tool to help them.”
“It’s an exciting development,” says Mr Leye Ajayi, “For many men, this could mean getting relief from urinary symptoms whilst preserving continence, sexual and ejaculatory function in most men.”
About Mr Leye Ajayi
Mr Leye Ajayi is a Consultant Urological Surgeon and Clinical Lead for Endourology at the Royal Free Hospital. He specialises in minimally invasive surgery for urinary tract stone disease and Benign Prostate Hyperplasia (BPH). His general urology practice includes andrology, rapid access prostate clinics, and haematuria (blood in urine) assessments. To learn more about Mr Ajayi, please click here.