Aquablation therapy

Where

In a hospital

Anesthesia

General, for the whole procedure

Time

Typically about an hour

Incisions

None; done through the urethra

Hospital stay

Usually home the same day; some men stay one night

Catheter

Usually for a short time after you go home

How Aquablation works

Aquablation is a resective procedure, which means the prostate tissue causing your symptoms is surgically removed. No incision is made in the abdomen. The prostate is reached through the urethra, the tube that carries urine out of the body.

What sets it apart is how the tissue is removed. Instead of heat from a laser or an electric loop, Aquablation uses a high-velocity waterjet with no heat. The waterjet is controlled by a robotic system and guided by live ultrasound. Because the plan is built around your own anatomy, it can be used for prostates of many shapes and sizes, including large ones. The goal is long-lasting relief with low rates of irreversible side effects.

The two steps of the procedure

1. Surgical planning

   Every prostate is a different size and shape. Aquablation combines ultrasound imaging with the standard camera used to look inside the urethra and bladder, called a cystoscope. On the ultrasound, Dr. Su maps exactly which parts of your prostate to remove and which to leave alone. Tissue inside the marked area can be removed, and tissue outside it stays untouched. This lets her avoid areas that could cause lasting problems with erections, ejaculation or bladder control if they were removed.

2. Tissue removal

   Once the map is set, a robotic system follows it and removes the targeted tissue with the heat-free waterjet. The robotic control helps make the removal precise, consistent and predictable. When needed, Dr. Su may use a small amount of cautery (gentle heat) afterward to control bleeding.

What about side effects?

Worry about side effects is the main reason men put off prostate surgery (4). In a survey, 85% of men said they were concerned that surgery would cause incontinence (leaking urine), and 4 out of 5 were concerned it would permanently affect their sexual function (4).

In clinical studies, men who had Aquablation had a very low rate of irreversible complications such as incontinence, ejaculation problems and erectile dysfunction (3). No procedure is free of risk, and Dr. Su goes over the risks with you before you decide.

Is Aquablation right for you?

Aquablation is a different kind of prostate surgery, and there are several reasons it may suit you. Whether you are a good candidate depends on your prostate, your symptoms and your overall health, so talk it through with Dr. Su.

1. Low rates of irreversible complications. Two features help keep rates of incontinence, ejaculation problems and erectile dysfunction low (1, 2):
   • The surgeon can see the entire prostate before removing anything and build a map that avoids the areas linked to these complications.
   • The tissue is removed with water instead of heat. Treatments that use heat to remove prostate tissue may damage the parts of the prostate that control erections and ejaculation. A small amount of cautery may still be used afterward to control bleeding.
2. Confidence in the procedure. The tissue is removed by a robotically controlled waterjet that follows the surgical plan, which is designed to minimize human error.
3. Long-term relief. In clinical studies, Aquablation provided relief that lasted through 5 years of follow-up (1, 2).
4. Results compared with TURP. Compared with transurethral resection of the prostate (TURP), Aquablation showed (5):
   • Similar symptom relief
   • A lower complication rate
   • Fewer repeat treatments
5. Clear gains in symptoms and flow. On average, men treated with Aquablation had (1, 2, 3):
   • A 16-point improvement on the International Prostate Symptom Score, a questionnaire scored from 0 to 35 where a higher score means worse symptoms
   • A 3.3-point improvement in their quality-of-life score
   • A 2x improvement in urinary flow rate

Before your procedure

Aquablation needs a simple bowel prep: two Fleet enemas, one the night before surgery and one the morning of surgery. You will also need a pre-operative visit with your primary care provider, and some medicines, such as aspirin and PDE5 inhibitors like sildenafil or tadalafil, are stopped a week ahead. Read the full pre-operative instructions.

Recovery

As with most prostate procedures, you wake up with a catheter, a thin tube that drains urine while the urethra heals. Dr. Su aims to send you home the same day, usually with the catheter still in place for a short time. Some men stay one night in the hospital when there is more bleeding in the urine than usual.

Once you are home, you may notice mild burning and urgency for several weeks. Urgency is a sudden, strong need to urinate that is hard to hold off. Mild pain medicine usually helps. You can return to your normal activities once Dr. Su says it is OK. Follow the discharge instructions you are given after surgery.

Questions patients ask

Safety information and references

Read the full risk and safety information for Aquablation therapy at aquablation.com/safety-information.

1. Gilling PJ, et al. Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind, randomized trial in men with LUTS due to BPH. Can J Urol. 2022 Feb;29(1):10960-10968.
2. Bhojani N, et al. Aquablation therapy in large prostates (80-150 mL) for lower urinary tract symptoms due to benign prostatic hyperplasia: final WATER II 5-year clinical trial results. J Urol. 2023;210(1):143-153.
3. Elterman D, et al. BMJ Surg Interv Health Technol. 2021.
4. Data on file at PROCEPT BioRobotics.
5. Oumedjbeur K, et al. Can J Urol. 2023.