Aquablation: Robotic-Controlled Waterjet to Treat Prostate Obstruction

Andrew Siegel MD/Michael Esposito MD 12/3/2022   

There are numerous methods of treating BPH (benign prostate hypertrophy), a common problem of the aging male that causes annoying lower urinary tract symptoms. These symptoms, among others, may include a hesitant, weak, intermittent, prolonged urinary stream, as well as urgency, frequency, and nighttime urination.

Aquablation is a new, advanced, minimally invasive treatment for BPH that uses imaging, robotics, and a waterjet to remove obstructing prostate tissue. The prostate is imaged via cystoscopy (a narrow scope and camera) and simultaneous ultrasound (sound waves that provide a 3-dimensional view in real time) in conjunction with a robotic-controlled high velocity heat-free waterjet to remove (ablate) obstructing prostate tissue that is targeted for removal. The procedure is rapid and uniquely –as compared to all the other means of treating BPH — image-guided using both cystoscopy and ultrasound.

The Aquablation System

The Aquablation procedure is performed in the hospital under anesthesia and requires an overnight stay and the use of a short term (1-2 day) urethral catheter to drain the urinary bladder. It is appropriate for a range of prostate sizes, spanning from 35 grams and up, and is particularly suited for very large prostates (100-500 grams) that previously needed to be addressed with open or robotic simple prostatectomy.

Since every prostate has a unique size and shape, a vital initial step is a customization process to map the patient’s specific anatomy and determine which areas of the prostate need to be removed and which are to remain. This is performed using robotics and advanced computer software and results in precise tissue targeting.

Once the surgical mapping and customization process is completed, the prostate is ablated using a robotically controlled, heat-free water jet using cooled saline as an irrigating solution. The water jet acts in a similar way to a pressure washer. Since the procedure is performed under constant cystoscopic and ultrasonic imaging, the ablative process can be modified as necessary. The robotic aspect allows for precision, minimization of human error, and consistent and predictable results. Because of the precision of targeting, side effects – including incontinence, retrograde ejaculation, and erectile dysfunction – occur only rarely.  There is no tissue specimen as the prostate is ablated into a slurry of liquid that is flushed out. 

Aquablation Animation

The advantages of Aquablation include its rapidity, ability to treat extremely large prostates, relatively non-invasive approach, and avoidance of side effects through precise imaging and targeting. A downside of Aquablation is bleeding that often requires additional technology (transurethral coagulation) to control.  A special instrument (resectoscope) is used to trim out (resect) fluffy tissue of the bladder neck region and to visualize and cauterize bleeding. Thereafter, a 3-way catheter is placed that allows for both irrigation and drainage of the urinary bladder.  The catheter will often be removed the following day, prior to discharge from the hospital.

Like any surgical procedure done for the treatment of BPH, it will take several weeks for the complete healing process and resolution of symptoms to occur. Clinical studies have demonstrated that the Aquablation procedure offers significant relief of BPH symptoms with low complication rates (minimal urinary control, erection, and ejaculation side effects).

Our urology group is now offering this procedure along with all of the other treatments for BPH.

Wishing you the best of health,

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro AreaInside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, one of the largest urology practices in the United States.  He is the co-founder of PelvicRx and Private Gym.  His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. 

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health


MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

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One Response to “Aquablation: Robotic-Controlled Waterjet to Treat Prostate Obstruction”

  1. alan baker Says:

    Look nice!Thanks!

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