Aquablation Surgery

Aquablation is a one of a kind, real time, minimally invasive, and robot assisted surgical procedure used to treat benign prostatic hyperplasia (BPH), also more commonly known as an enlarged prostate. 

First introduced to the urologic community in 2013 and cleared by the Food and Drug Administration in 2017, Aquablation is a transformative resective therapy that brings relief to men suffering from lower urinary tract symptoms (LUTS). This surgical procedure was developed by PROCEPT BioRobotics, a surgical robotics company based in Silicon Valley, but more specifically Dr. Nikolai Aljuri, the principal architect of the AquaBeam technology. 

This procedure consists of two main steps, both of which take place after the patient has undergone general (or, in some cases, spinal) anesthesia. Firstly, a custom tailored robotic imaging machine is inserted into the body with a cytoscope, used in combination with ultrasound imaging. This creates a precise surgical map and plan, giving the surgeons a clear picture of what prostate tissue needs to be removed, sparing structures in the urinary tract and lowering the risk of complications such as ejaculation problems. As the only procedure that gives the surgeon the advantage of viewing the entire prostate multidimensionally and in real-time, Aquablation drastically increases precision and accuracy of the surgery. Secondly, a robotically controlled heat-free water jet follows the created plan, carefully performing the resection of the excess problematic prostate tissue. Combined, the entire procedure typically takes less than half an hour to complete. 

After the surgery, most patients stay for two or three hours in the recovery room, where they are monitored as they wake up from the anesthesia and also where they will be fitted post-procedure with a catheter which allows for urination and can rinse the inside of the bladder to clear away bleeding. The catheter stays in place until the doctor decides the urine is clear enough of blood and debris, thus some spend a night in the hospital while others can be discharged the same day once they have recovered from the anesthesia.

As Aquablation is a minimally invasive, robotically performed procedure, it comes with many benefits, including a wide accommodation of any size or shaped prostate, precise digital mapping through real-time imaging, robotic precision, incision-free, sphincter and ejaculatory  preservation, long-lasting relief, and maintained urinary and sexual functions. In comparison to alternative treatments such as transurethral resection of the prostate (TURP), urine flow and BPH symptom reduction were comparable between the two groups, and Aquablation had fewer side effects than TURP, especially regarding preserving the ability to ejaculate. However, it should be noted that some side effects difficulty urinating, frequent urination, mild burning, and other effects similar to such—but they are typically mild and temporary. 

Although Aquablation treatment is relatively new, a study published in October 2023, concludes that Aquablation is an effective method for treatment of men with urinary retention, especially noting that 98% of the subjects in the study were able to urinate spontaneously after the treatment. This brings great hope to further robotic developments within the surgical industry, and increasing the benefits reaped from them.

Written by Renee Wang at Incisionary

References

Aquablation. (n.d.). Johns Hopkins Medicine. Retrieved January 25, 2026, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-prostatic-hyperplasia-bph/aquablation

Patient-Friendly Guide to Understanding Aquablation® Therapy. (2024, May 13). Aquablation. Retrieved January 25, 2026, from https://aquablation.com/blog/patient-friendly-guide-to-aquablation-therapy/