Aquablation is a minimally invasive surgical technique used to treat benign prostatic hyperplasia (BPH), a condition in which the prostate gland becomes enlarged and causes urinary symptoms in men. BPH, also known as enlarged prostate, becomes problematic when excess prostate tissue presses against the urethra, the tube that carries urine out of the body, obstructing the flow of urine. The condition is common as men age and can lead to issues such as frequent urination, a weak urine stream, difficulty starting urination, and the sensation of not fully emptying the bladder.

The procedure uses a robotically controlled, high-pressure saline jet to remove the extra prostate tissue pressing against the urethra, helping to restore urine flow and relieve symptoms.

Aquablation is a minimally invasive, robot-assisted surgery for treating BPH. It uses a high-velocity jet of sterile saline to remove excess prostate tissue, without relying on heat or traditional cutting instruments. The approach is designed to precisely target and remove—or ablate—the excess prostate tissue that presses against the urethra while minimizing damage to surrounding structures.

The robotic system is composed of several integrated components designed to maximize surgical precision and safety. The system includes a conformal planning unit (CPU), a console, and a robotic handpiece. The CPU serves as the central hub, allowing the surgeon to visualize the prostate in real time using ultrasound imaging. The imaging enables the surgeon to map out the exact regions of the prostate to be removed while preserving nearby critical structures.

The console is used to program and control the ablation parameters, including the depth and angle of tissue removal, which can be customized for each patient’s anatomy. The robotic handpiece, which is inserted through the urethra, delivers the high-pressure stream of saline. Automated, robotic guidance ensures consistent tissue removal, regardless of prostate size or shape.

Aquablation is used to treat BPH, a non-cancerous enlargement of the prostate gland. The prostate is a walnut-sized gland located below the bladder and in front of the rectum. It surrounds the urethra and also produces a fluid that is a component of semen. As men age, prostate cells proliferate. This causes the prostate to enlarge, resulting in BPH. The enlarged prostate can press against the urethra, which often causes bothersome lower urinary tract symptoms. These symptoms may include:

• Difficulty starting urination
• Weak urine stream
• Frequent urination, especially at night
• Urgency to urinate
• Incomplete bladder emptying
• Urinary retention (inability to urinate)

Aquablation is especially helpful for men with moderate to severe symptoms who have not found relief with lifestyle changes or medications. The procedure is suitable for a wide range of prostate sizes, including small, medium, and large prostates.

Men who have moderate to severe lower urinary tract symptoms caused by BPH and have not found enough relief with lifestyle changes or medications usually are good candidates for aquablation. It is often recommended for men who wish to preserve sexual function, as the procedure has a lower risk of causing ejaculatory dysfunction compared to some other surgical treatments.

Ideal candidates are men who do not have active urinary tract infections, confirmed or suspected prostate cancer, or conditions that prevent them from safely stopping blood-thinning medications before surgery.

Before having aquablation, patients have a preoperative assessment, which may include a urine flow test, completion of symptom questionnaires, and other medical evaluations to ensure they are suitable for the procedure. Men taking blood-thinning medications may be asked to stop them for a period before the treatment to reduce the risk of bleeding.

On the day of the procedure, patients having aquablation arrive at the hospital several hours before the scheduled surgery. Antibiotics may be given through a vein to help prevent infection, and may also be taken orally after the operation.

Aquablation is performed as a minimally invasive surgical procedure, usually in a hospital setting under general or spinal anesthesia, so pain is not felt during the treatment. Once anesthetized, an ultrasound probe is inserted into the rectum to provide real-time images of the prostate, and a specialized handpiece with a cystoscope (a thin tube equipped with a camera and light) and ablation probe is inserted through the urethra into the bladder.

Using advanced imaging and planning software, the surgeon maps out the areas of the prostate to be removed, carefully preserving important structures that control sexual and urinary function. The robotic system then delivers a high-pressure, heat-free saline jet to precisely remove the targeted prostate tissue according to the treatment plan. The ablated tissue is aspirated (removed by suction) through the device and can be sent for analysis if needed.

After the tissue is removed, the doctor controls any bleeding, and inserts a small tube called a catheter through the urethra into the bladder. The catheter allows for a steady flow of fluid to flush the bladder and help prevent blood clots.

After aquablation, most patients stay in the hospital overnight, for observation and to allow for continuous bladder flushing through a catheter, which helps prevent blood clots and manage any bleeding. The catheter is usually removed before discharge, often the next day.

Most patients can go home once they are able to urinate on their own. They may be given a short course of antibiotics to help prevent infection and advised to take pain relievers such as acetaminophen for any mild discomfort.

During the first few weeks after the procedure, it is normal to experience some mild pain or discomfort when urinating, blood in the urine, or increased urinary frequency and urgency. These symptoms usually improve within a few days to weeks, but it may take up to three months to see the full benefit of the procedure. People can gradually return to normal activities, avoiding strenuous exercise until they feel comfortable, and follow their doctor’s instructions about resuming work and sexual activity—typically, ejaculation should be avoided for six weeks after the procedure.

Regular follow-up appointments are scheduled to monitor the healing process and ensure the best possible outcome. Most people notice significant improvement in their urinary symptoms within the first two weeks, with continued improvement over the following months.

As with any surgical procedure, aquablation carries some risks and potential side effects. The most common side effects are mild and temporary, including pain or discomfort when urinating, pelvic discomfort, blood in the urine, increased urinary frequency or urgency, and mild difficulty emptying the bladder. Some patients may also experience urinary tract infections or temporary urinary retention.

More significant complications are rare but can include bleeding that may require a blood transfusion or a return to the operating room to control the bleeding. The risk of major bleeding is higher in men with larger prostates, but careful management during and after the procedure helps reduce this risk. There is also a low risk of injury to the urethra or rectum, and a small chance of developing ejaculatory dysfunction or, rarely, incontinence (loss of bladder control).

Most side effects improve within a few weeks, and serious complications are uncommon. If any significant issues arise, such as difficulty passing urine, signs of infection, or heavy bleeding, prompt medical attention is important. Health care providers monitor patients closely during and after the procedure to manage any complications and ensure a safe recovery.

Most patients experience significant and lasting improvement in urinary symptoms, with benefits that have been shown to last for at least five years. Studies have found that aquablation provides symptom relief and improved urine flow that is comparable to, or better than, traditional surgical treatments such as transurethral resection of the prostate (TURP). The risk of needing additional treatment for recurrent symptoms is low, with fewer than 10% of patients requiring further therapy within five years.

Aquablation is associated with a lower risk of sexual side effects, including ejaculatory dysfunction and erectile dysfunction, compared to some other surgical options. Most people are able to return to normal activities within a week or two, and the majority notice symptom improvement during this time.

“The addition of aquablation to the possible treatment options for BPH confirms Yale’s unwavering commitment to providing the state-of-art care to our patients,” says Issac Yi Kim, MD, PhD, MBA, chair of the Department of Urology at Yale School of Medicine.