What is robotic Aquablation?
Robotic Aquablation is a minimally invasive surgical treatment for men with lower urinary tract symptoms (LUTS) resulting from an enlarged prostate, a condition also known as benign prostatic hyperplasia (BPH).
Aquablation surgery is performed using the AquaBeam robotic system developed by Procept BioRobotics and uses a heat-free, high-velocity water jet to remove excess prostate tissue precisely.
This innovative procedure combines real-time imaging, robotics, and waterjet ablation technology to treat urinary symptoms associated with benign prostatic hyperplasia (BPH).
Why is this procedure performed?
When medications fail to provide relief from symptoms like frequent urination, weak stream, urgency, or incomplete bladder emptying, or when those symptoms become disruptive, our urologist may recommend Aquablation as a surgical treatment option.
Who is the ideal candidate for Aquablation of the prostate?
Ideal candidates include:
- Men with moderate to severe BPH symptoms.
- Those with larger prostate glands (typically over 40 grams), for whom other minimally invasive procedures may not be effective.
- Men concerned about preserving sexual function, including ejaculation.
- Patients who want a less invasive alternative to traditional surgery.
How is Aquablation performed?
Aquablation of the prostate uses a combination of robotic technology and high-pressure water jets guided by real-time ultrasound imaging.
The procedure is performed under anesthesia and involves two main steps.
- The first step is called surgical mapping. Here, we use a combination of transrectal ultrasound imaging and camera (cystoscope) technologies to create a detailed, multidimensional map of the prostate. This allows our surgeon to precisely select which tissue areas to remove and which to preserve.
- The second step is the removal of robotic tissue. Once the surgical map is drawn, a robotically controlled water jet filled with unheated saline solution precisely removes the targeted prostate tissue. The removed (or ablated) tissue is then extracted through the handpiece and can be used for further examination by our lab.
What are the benefits of robotic Aquablation?
Aquablation therapy is an attractive option for our prostate patients with many advantages, including:
Great precision and surgical customization
The combination of ultrasound imaging and robotic control allows for highly personalized treatment with consistent, reproducible results regardless of prostate size or anatomy.
Preservation of sexual function
Unlike heat-based treatments, Aquablation uses an unheated saline solution that helps prevent nerve damage, which reduces the risk of sexual dysfunction and, in most cases, preserves ejaculatory function.
Effective for all prostate sizes
The procedure can effectively treat prostate enlargement regardless of size (up to 150cc).
Shorter recovery time
Aquablation therapy works by accessing the prostate through the urethra rather than through an incision, which allows for minimal downtime after surgery.
Lower risk of complications
Because there is no heat used in this procedure, the risk of complications like incontinence and erectile dysfunction is minimized compared to traditional surgical methods.
What is Aquablation’s success rate?
Aquablation prostate surgery has very high success rates:
- Over 90% of men report symptom relief.
- Even men with very large prostates report excellent long-term outcomes.
- Retreatment rates are low compared to older techniques.
What are Aquablation’s side effects?
Aquablation’s risks are low, but side effects can include:
- Bleeding (occasionally requiring a transfusion)
- Temporary urinary retention or infection (e.g., urinary tract infection)
- Rare need for repeat surgery
- Sexual side effects (but risks are significantly lower compared to any other surgical options)
What is Aquablation recovery time like?
Most patients stay in the hospital for one night, wear a catheter for two to five days, and return to normal activities within one to two weeks.
Improvements in urination are noticeable soon after the catheter is removed and continue to improve over several weeks.
Are there other procedures to consider instead of Aquablation of the prostate?
Yes, depending on the prostate size and patient goals, the following alternatives are available:
- Medications (alpha-blockers, 5-alpha reductase inhibitors)
- UroLift or Rezūm (for smaller prostates)
- TURP (transurethral resection of the prostate)
- Laser procedures (HoLEP, GreenLight)
- Robotic simple prostatectomy (for extremely large glands)
Aquablation sits in a sweet spot: effective for large prostates, with lower sexual side effects than TURP or laser surgery.
Though no surgery is ever risk-free, Aquablation is one of the most precise and least invasive options available for large prostates.
What sets Tower Urology apart from other practices regarding how you perform this procedure?
At Tower Urology, we were early adopters of Aquablation and remain high-volume providers of the procedure, which means we have extensive experience unmatched by anyone else in Southern California. This offers our patients several advantages:
- Procedures are custom-tailored using advanced imaging and robotic guidance for precise, patient-specific results.
- We prioritize preserving sexual function and maximizing urinary relief, and that’s reflected in our patient outcomes.
- Our entire team — from surgeons to support staff — is dedicated to streamlined care, long-term relief, and fast recovery.
Aquablation prostate surgery is one of the few treatments for BPH that gives you real relief without sacrificing your quality of life. It’s safe and effective and preserves what matters most to men — function, confidence, and peace of mind. Recovery is quick, and most guys who undergo the surgery say they wish they had done it sooner.
Why is Tower Urology the best Los Angeles provider for Aquablation?
At Tower Urology, we take a personalized, evidence-based approach to general urology care. All our professionals are committed to providing you with expert care. We take the time to understand you and personalize your treatment plan to your needs.
We invite you to establish a care plan with Tower Urology.
Tower Urology is conveniently located for patients throughout Southern California and the Los Angeles, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Burbank, Glendale, and Downtown Los Angeles.
Services include treatment for enlarged prostate (BPH), Rezum procedure, robotic prostatectomy, and UroLift.
Aquablation FAQs
Yes, Aquablation therapy for benign prostatic hyperplasia (BPH) is covered by many insurance plans, including Medicare and numerous commercial insurance providers, when specific medical criteria are met.
Medicare has covered Aquablation therapy for all eligible Medicare patients since December 2020. Medicare will cover one Aquablation treatment per lifetime if you meet the following requirements:
- Your doctor determines that it’s medically necessary.
- Your prostate volume is between 30 and 150 cc as measured by transrectal ultrasound.
- You have persistent moderate to severe symptoms with an International Prostate Symptom Score ≥12.
- You have a maximum urinary flow rate ≤15 ml/s.
- You have tried conventional medical therapy for at least three months without success or have contraindications to such treatment.
- The procedure uses an FDA-approved device.
Aquablation is typically not recommended for patients who have:
- A history of previous prostate surgery
- A history of radiation therapy
- Severe bleeding disorders
- Severe heart disease
- Severe kidney disease
Comparing Aquablation to other treatments for BPH relief
Robotic Aquablation employs a heat-free water jet guided by robotic precision and real-time imaging to remove prostate tissue, resulting in shorter procedure times (typically 45 minutes compared to 60-90 minutes for TURP), less bleeding, and better preservation of sexual function.
Let’s look at how it compares with other treatments.
Robotic Aquablation and transurethral resection of the prostate (TURP) are both treatments for an enlarged prostate, but they differ significantly in their approach and outcomes.
TURP, the traditional gold standard treatment, utilizes an electrified loop to cut and cauterize prostate tissue, which can lead to more complications, including retrograde ejaculation (affecting 65%-75% of patients compared to only 35% with Aquablation).
While both procedures effectively relieve urinary symptoms, Aquablation provides more consistent results regardless of prostate size, with fewer side effects and a quicker recovery time. However, it may require a slightly longer catheterization period (one to two days versus one day for TURP).
Aquablation and Rezum are both modern treatments for an enlarged prostate (BPH), but they work differently.
Rezum uses steam (water vapor) to shrink prostate tissue over several weeks to months and can be performed in an office setting under local anesthesia.
While both treatments show good symptom improvement, Aquablation typically delivers faster and more dramatic results, but requires a hospital visit. Rezum offers the convenience of an outpatient procedure with a shorter recovery time, but improvements are more gradual. Aquablation has a lower rate of ejaculatory dysfunction (7%) compared to other surgical options, while Rezum has a slightly lower rate (5%).
Aquablation and UroLift are both minimally invasive treatments for benign prostatic hyperplasia (BPH), but they work differently.
Aquablation uses a heat-free water jet to precisely remove excess prostate tissue, while UroLift uses implants to hold the prostate tissue away from the urethra.
Aquablation typically requires general anesthesia, while UroLift, on the other hand, can often be performed under local anesthesia as an outpatient procedure and has shown superior preservation of sexual function. However, it’s generally more suitable for moderate-sized prostates.
Both treatments aim to improve urinary symptoms while minimizing the impact on sexual function, but the choice between them depends on factors like prostate size, anatomy, and individual patient preference.
Sources
Aquablation Essentials: Patient Candidacy & Procedure Protocols
https://www.backtable.com/shows/urology/articles/prostate-Aquablation-procedure-protocols
Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation
https://www.nature.com/articles/s41391-023-00669-z
Minimally Invasive Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis
https://pubmed.ncbi.nlm.nih.gov/34968671
BPH Treatment with Lasting Relief – Aquablation®
https://Aquablation.com
