Procedure guide · 7 min read

Aquablation: robotic water-jet treatment for the prostate

Last updated: 4 May 2026 · Reviewed by Mr Sanjay Rajpal, Consultant Urological Surgeon · GMC 6106646

Aquablation is a relatively new treatment for an enlarged prostate that combines two ideas: a surgeon plans the area to be removed using real-time ultrasound imaging, then a robot delivers a high-pressure water jet to remove the obstructing tissue with millimetre precision. There is no heat involved in the cutting step, which is the key reason for its low impact on sexual function.

Key point: Aquablation is appealing for men who want predictable symptom improvement while preserving ejaculation as much as possible, especially when the prostate is moderate to large in size.

How Aquablation works

The operation is done under general anaesthetic. A small ultrasound probe placed in the rectum gives a live picture of the prostate. Through a telescope in the urethra, Mr Rajpal maps the area of tissue to be removed — protecting the bladder neck, sphincter and ejaculatory ducts. The robotic system then delivers a controlled, heat-free water jet that follows the planned shape. A short, focused step at the end seals any small bleeding vessels.

Who Aquablation suits

Men with moderate-to-large prostates, including over 80 ml.
Men who place a high value on preserving ejaculation.
Men with anatomy that makes other treatments less suitable.
Men who want a single, definitive day-stay or one-night procedure.

Alternatives

The main alternatives are HoLEP, Greenlight laser, TURP, UroLift, Rezum and iTIND. Each has trade-offs in terms of bleeding risk, ejaculation, durability and prostate size limits. For men with very large prostates and a wish to avoid a long catheter, HoLEP is often considered. For men prioritising ejaculation with smaller prostates, UroLift or Rezum may suit better.

What happens on the day

You will be admitted on the day of surgery. The procedure usually takes 45–90 minutes. A catheter is left in place to allow the prostate to settle. Most men stay one night and go home with the catheter removed at 24–48 hours, depending on the urine clarity and bladder behaviour.

Recovery

First week: mild burning, urgency and traces of blood — settles with hydration.
Weeks 2–4: flow improves; avoid heavy lifting and long-distance cycling.
Six weeks: most men are back to normal activity, including travel and exercise.
Three months: review with flow testing to confirm the result.

Risks and side-effects

Most side-effects are temporary: urgency, mild burning, blood in the urine and short-lived stress leakage. Bleeding requiring readmission is uncommon. Retrograde ejaculation may occur but is reported less often than with HoLEP or TURP. Urinary tract infection, urethral stricture and the need for a further procedure are uncommon but possible.

When to seek help after Aquablation

Heavy bleeding or clots blocking your urine flow.
Inability to pass urine after the catheter has been removed.
Fever, shivering or worsening pain in the days afterwards.
Persistent leakage that is not improving over weeks.

Questions to ask before booking

Am I a good anatomical candidate for Aquablation?
How does the durability compare with HoLEP for my prostate size?
How important is ejaculation to me, and how does that change the recommendation?
What experience does Mr Rajpal have with the AquaBeam system?