Aquablation: The Future of Enlarged Prostate Treatment with Fewer Side Effects

Aquablation: A Promising New Treatment for Enlarged Prostate with Fewer Side Effects

Introduction to Aquablation and Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) is a common condition in older men, with more than 50% of men over the age of 50 and 80% of men over the age of 70 affected globally. As men age, their prostate gland may grow, causing it to press against the urethra, leading to various urinary symptoms such as frequent urination, weak urine flow, and urinary incontinence. While BPH is non-cancerous, it can significantly affect a man’s quality of life.

For many patients, when lifestyle changes and medications no longer provide relief, surgery becomes an option. Traditional surgical treatments for BPH, such as transurethral resection of the prostate (TURP), utilize a wire loop or laser to remove excess prostate tissue. However, these treatments are associated with side effects, including retrograde ejaculation, where semen is ejaculated into the bladder instead of through the penis. While retrograde ejaculation is not harmful, it can reduce sexual satisfaction and fertility, making it a major concern for many men undergoing BPH surgery.

In recent years, Aquablation, a minimally invasive procedure using high-pressure water jet technology, has emerged as a promising alternative to standard BPH treatments. The WATER III trial, presented at the 2025 European Association of Urology (EAU) Congress in Madrid, provided compelling evidence on the effectiveness and safety of Aquablation, particularly in preserving ejaculatory function.

What Is Aquablation?

Aquablation is a novel surgical technique that uses a high-pressure water jet to remove excess prostate tissue under robotic guidance and real-time ultrasound imaging. This procedure has shown promise, especially in patients with larger prostates, where traditional laser-based treatments may be more challenging or less effective. Unlike laser treatments, which vaporize or break up prostate tissue, Aquablation uses water to precisely target and destroy the tissue, minimizing damage to surrounding areas.

The advantage of robot-assisted Aquablation lies in its ability to perform precise and controlled tissue removal, while minimizing the risk of complications such as retrograde ejaculation, a common side effect of other BPH surgeries. Furthermore, Aquablation can be performed in a shorter time, with fewer complications and faster recovery periods, improving the overall patient experience.

The WATER III Trial: Findings and Implications

The WATER III trial, led by researchers from the University of Bonn, recruited 202 men who required surgery for their BPH and had large prostates ranging between 80 – 180 mL. The study compared the outcomes of Aquablation to two standard laser treatments for BPH: Holmium laser prostate surgery (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP).

After three months of follow-up, patients were assessed for various factors, including retrograde ejaculation, urinary incontinence, and the severity of their lower urinary tract symptoms (LUTS) using the International Prostate Symptom Score (IPSS). The results were compelling:

• Retrograde ejaculation was reported in 15% of men in the Aquablation group, compared to 77% of men in the laser surgery group.
• Urinary incontinence was observed in 9% of men who underwent Aquablation, compared to 20% in the standard treatment group.
• Symptom improvement was similar across both groups, with significant relief in urinary symptoms and quality of life.

These findings suggest that Aquablation could offer a substantial advantage in terms of preserving ejaculatory function while providing similar symptom relief and effectiveness when compared to traditional laser surgery.

Why Aquablation Is a Game Changer

One of the most significant benefits of Aquablation is its ability to preserve sexual function, particularly for men concerned about retrograde ejaculation. While retrograde ejaculation is not medically harmful, it can negatively affect a man’s sexual satisfaction and fertility. With the Aquablation procedure, men can expect fewer side effects, particularly in terms of preserving their ejaculatory function compared to standard treatments like TURP and laser surgery.

Moreover, the robotic-assisted technology in Aquablation allows for greater precision in targeting and removing prostate tissue, which minimizes the risk of damaging surrounding tissues. This precision also leads to shorter recovery times and less bleeding compared to traditional surgeries.

Additionally, the learning curve for surgeons performing laser surgery can be steep, especially for those treating larger prostates. Aquablation’s more intuitive procedure may provide a more accessible treatment option for surgeons and enable quicker adoption, making it easier to treat patients with larger prostates and reduce waiting times for treatment.

Long-Term Potential and Future Research

While the results of the WATER III trial are promising, the follow-up period was limited to three months. Longer-term studies are necessary to assess the long-term effects of Aquablation on BPH treatment, including its impact on urine flow rates, prostate-specific antigen (PSA) levels, and the durability of symptom relief. Future trials will also need to explore the effectiveness of Aquablation in treating patients with chronic urinary retention or those requiring urethral catheters, as these patients often represent a more complex group requiring tailored treatment.

Additionally, Professor Cosimo De Nunzio, Associate Professor of Urology at Sapienza University of Rome, emphasized the importance of investigating other key measures in future studies, such as reduction in PSA levels and improved urine flow, to better understand the comprehensive benefits of Aquablation for men with BPH.

Conclusion: The Future of BPH Treatment

The WATER III trial has demonstrated that Aquablation is a promising alternative to traditional laser treatments for men with BPH, particularly for those with larger prostates. The procedure offers similar outcomes to standard treatments but with the added benefit of preserving ejaculatory function and reducing the risk of urinary incontinence. For many men, this new technique may offer not just improved urinary function but also a better quality of life by preserving sexual health.

For healthcare providers, Aquablation may represent an important step forward in the treatment of BPH, with robot-assisted technology offering a faster, safer, and more efficient option. As long-term studies continue to unfold, Aquablation may become the standard for BPH surgeries, giving patients a more tailored and less invasive solution to managing their condition.