Robotic Waterjet Surgery for Enlarged Prostate: A Urologist’s Guide to Aquablation Therapy

Q: "What can I expect during recovery?"

Because Aquablation is a formal surgical procedure performed under general or spinal anesthesia in an operating room, the immediate recovery differs from an in-office treatment:

Dr. Sarp Korcan Keskin
Aug 6
4 min read

By Prof. Keskin, Consultant Urological Surgeon

When treating Benign Prostatic Hyperplasia (BPH)—the non-cancerous enlargement of the prostate gland—urologists face a classic medical dilemma: how to remove enough tissue to deliver powerful, lasting relief to a man's urinary stream without causing permanent damage to his sexual function.

Traditional surgical methods like TURP (Transurethral Resection of the Prostate) or laser surgery effectively carve away obstructing tissue, but they carry a high rate of dry orgasms (retrograde ejaculation) or erectile complications. Meanwhile, less invasive office procedures preserve sexual function well, but can be less effective for very large or complex prostates.

Aquablation therapy was developed precisely to solve this dilemma. By combining real-time ultrasound imaging, robotic precision, and heat-free waterjets, Aquablation offers surgical-grade clearance for prostates of any size while preserving sexual function.

Here is my detailed guide answering the core questions patients ask when considering Aquablation.

"What is Aquablation, and how does robotic waterjet technology work?"

Aquablation is an advanced, minimally invasive surgical procedure that uses a high-velocity, heat-free jet of water to precisely resect obstructing prostate tissue.

Unlike traditional techniques that rely on thermal energy (heat, lasers, or electrical cautery) to burn or vaporize tissue—which can cause heat damage to surrounding nerves responsible for erection and ejaculation—Aquablation uses purely physical water power.

The procedure involves three key technological steps:

[ Step 1: Dual Mapping ] ──> [ Step 2: Robotic Treatment Plan ] ──> [ Step 3: High-Speed Execution ]
 Standard cystoscopic view     Real-time ultrasound overlay to       Robotic waterjet executes the
 paired with live ultrasound.   map exact tissue boundaries.          resection in under 5 minutes.

Real-Time Dual Imaging: We insert a camera into the urethra alongside a transrectal ultrasound probe. This provides a multi-dimensional, live view of the entire prostate gland, allowing us to see exactly where the prostate tissue ends and where critical structures (like the ejaculatory ducts and urinary sphincter) begin.
Robotic Mapping: Using a computer interface, I draw a precise treatment boundary directly onto the screen. I define down to the millimeter where the waterjet should carve and where it must stop.
Autonomous Waterjet Resection: Once the map is locked, a robotic arm executes the plan automatically. A high-pressure waterjet sweeps across the designated zone, gently washing away the obstructive tissue in less than 5 minutes, regardless of prostate size.

"Why choose Aquablation? (The Big Advantages)"

Patients usually seek out Aquablation for three distinct reasons:

No Prostate Size Limit: Whether a prostate is 30cc, 80cc, or over 150cc, Aquablation handles the tissue with equal speed and precision. Traditional TURP or office procedures often struggle or are unsafe for very large glands.
Preservation of Sexual Health: Because the waterjet generates zero heat and the robot follows a mapped line that stays clear of the ejaculatory ducts and erectile nerves, Aquablation has unprecedented sexual preservation rates for a surgical procedure.
Consistency and Precision: By removing human tremor and hand-eye estimation from the tissue cutting phase, the robotic execution ensures that the exact plan designed by your surgeon is executed perfectly every time.

How Does Aquablation Compare to Other BPH Treatments?

To understand where Aquablation fits, compare it against traditional surgery and heat-based alternatives:

Feature / Metric	TURP (Traditional Surgery)	Rezūm (Steam Therapy)	Aquablation (Robotic Waterjet)
Gland Size Range	Best for <80cc.	Best for 30cc–80cc.	Any size (30cc to 150cc+).
Mechanism	Thermal (Electric loop burn).	Thermal (Steam energy).	Heat-Free High-Velocity Water.
Procedure Setting	Hospital Operating Room.	Clinic / Outpatient.	Hospital Operating Room.
Ejaculatory Preservation	Low (~20–30% preserved).	High (~90–95% preserved).	Very High (~85–90% preserved).
Erectile Preservation	Moderate to High (~95%).	Extremely High (~99%).	Extremely High (~99%).
Catheter Post-Op	1 to 3 days.	3 to 7 days.	1 to 2 days (overnight stay).

"What can I expect during recovery?"

Because Aquablation is a formal surgical procedure performed under general or spinal anesthesia in an operating room, the immediate recovery differs from an in-office treatment:

Hospital Stay & Catheter (1 to 2 Days)

Unlike thermal treatments that cauterize blood vessels while cutting, a heat-free waterjet leaves small raw blood vessels exposed. Therefore, after the waterjet finishes, we briefly use a cautery or balloon catheter to seal blood vessels. You will stay overnight in the hospital with a catheter while light fluid irrigates your bladder to keep the urine clear. The catheter is typically removed before you go home or within 48 hours.

Early Recovery (Weeks 1 to 4)

Urinary Symptoms: Mild burning, frequency, and urgent trips to the toilet are normal for the first 2 to 4 weeks as the internal surgical site heals.
Pink-Tinged Urine: It is normal to see light blood or small tissue specks in your urine for a few weeks. Drinking plenty of water helps flush the system clear.
Activity: Avoid heavy lifting (>5 kg), intense exercise, or sexual intercourse for 3 to 4 weeks to allow blood vessels to seal completely.

Long-Term Outcome (1 Month Onward)

Most men experience a dramatic increase in urine flow rate and significant reductions in nighttime waking within 3 to 6 weeks. Long-term studies show that symptom relief remains stable years after the procedure.

"What are the risks and drawbacks of Aquablation?"

While Aquablation is highly effective and safe, no surgical procedure is without potential trade-offs:

Bleeding Risk: Because no heat is used during the primary tissue removal, the risk of post-operative bleeding is slightly higher compared to laser procedures (such as HoLEP). Men taking blood thinners must stop their medication temporarily prior to surgery under medical supervision.
Requires Hospitalization: Unlike office-based procedures, Aquablation requires an operating room, general/spinal anesthesia, and usually an overnight hospital stay.
Temporary Retrograde Ejaculation: While sexual preservation rates are exceptionally high for a major tissue-resection surgery, approximately 10% to 15% of men may still experience retrograde ejaculation depending on how close to the bladder neck the tissue was removed.

Final Thoughts from Prof. Keskin

If you have a large or complex prostate, want surgical-grade relief from your urinary symptoms, and are unwilling to accept the high sexual side-effect rates associated with traditional TURP, Aquablation is one of the most remarkable technological advancements modern urology has to offer.

By uniting live ultrasound imaging with robotic waterjet precision, it removes the guesswork and protects what matters most to your quality of life. Ask your urologist whether an ultrasound measurement of your prostate shows you are a good candidate for robotic waterjet therapy.