The short answer
Aquablation uses a robot-controlled, image-guided waterjet to remove enlarged prostate tissue without heat. It works across a wide range of prostate sizes and tends to preserve ejaculation better than TURP. Its main trade-off is a higher chance of bleeding, occasionally needing a transfusion, so candidacy and a surgeon experienced with the system matter.
Where Aquablation fits among BPH procedures
Aquablation
A wide range of prostate sizes when preserving ejaculation matters and you want a heat-free, robot-guided resection.
How is bleeding managed in your practice, and how many Aquablation cases has the surgeon done?
TURP
Moderate-to-large prostates needing a durable, widely available benchmark procedure.
How does Aquablation's ejaculation preservation compare with TURP for my anatomy?
HoLEP
Any size, including very large; durable enucleation that is highly operator-dependent.
For my prostate size, would HoLEP or Aquablation give a more durable result?
Simple prostatectomy
Very large prostates (often over 80-100 g) when endoscopic options are less ideal.
Is my prostate large enough that surgical removal is a better fit than Aquablation?
What Aquablation is and why size doesn't limit it
Aquablation treats an enlarged prostate with a heat-free, high-pressure waterjet that is guided by the surgeon using real-time ultrasound imaging and delivered by a robotic system. The urologist maps the tissue to remove on the ultrasound image, and the robot removes it precisely while sparing the areas tied to ejaculation and continence.
Because it does not rely on cutting loop by loop the way TURP does, Aquablation can be used across a wide range of prostate sizes, including larger glands that might otherwise point toward enucleation (HoLEP) or open or robotic surgical removal. That size flexibility, plus its aim of protecting sexual function, is its main appeal.
The bleeding trade-off (the honest downside)
The downside competitors tend to gloss over is bleeding. Because Aquablation removes tissue with water rather than heat, it does not seal blood vessels as it goes, so there can be more bleeding than with heat-based procedures. Most surgeons control this by cauterizing afterward or briefly placing traction on the catheter, but a transfusion is needed in a small number of cases.
Other recognized downsides include temporary blood in the urine, irritative urinary symptoms while healing, urinary tract infection, and the small risks that come with any prostate procedure. Honest framing of the bleeding question — and how a given surgeon manages it — is exactly what should be part of your decision.
Who is and isn't a candidate
Aquablation is generally considered by men with bothersome BPH symptoms across a broad range of prostate sizes who want to preserve ejaculation and prefer a heat-free, image-guided resection. It can treat a median (middle) lobe, which some less-invasive options cannot.
It is a procedure done in an operating room under anesthesia, so men who are not fit for anesthesia, or who specifically want an office-based or non-surgical option, may be steered elsewhere. As with any BPH surgery, a urologist should rule out other causes of symptoms first. Men on blood thinners or with bleeding tendencies need a careful, individualized discussion given the bleeding profile above.
Recovery, durability, and choosing a center
Most men stay overnight with a catheter, which usually comes out within a day or two once the urine clears. Expect to avoid heavy lifting, vigorous exercise, and sexual activity for several weeks while the inside heals, with some burning, urgency, and intermittent blood in the urine during that time.
Early and medium-term results for symptom relief are strong, and Aquablation tends to preserve ejaculation better than TURP; very long-term durability data is still maturing because it is a newer procedure. Because it relies on a specific robotic system and a trained team, it is offered at a limited number of centers — so part of the decision is finding a surgeon experienced with it.
There is no single best enlarged-prostate procedure. The right choice depends on prostate size, how much you want to protect ejaculation, whether you take blood thinners, how durable a result you need, and your anesthesia preference. A urologist who offers more than one option can compare them for your anatomy.
What shapes Aquablation cost and access
- Center availability
- Aquablation requires a specific robotic system and trained team, so it is offered at a limited number of hospitals. Travel to a center that has it can be part of the real cost, and availability may shape your options more than price.
- Hospital and anesthesia setting
- It is done in an operating room under spinal or general anesthesia, usually with an overnight stay. Facility and anesthesia fees are typically the largest line items and vary widely by location and insurer.
- Prostate size
- Aquablation is used across a broad size range, including larger glands. Size affects operating time and planning, and it is part of how a urologist decides between Aquablation, HoLEP, and simple prostatectomy.
- Insurance and pre-authorization
- Many plans cover Aquablation for symptomatic BPH, but coverage is less universal than for TURP, and facility, anesthesia, and pathology charges may be billed separately. Confirm pre-authorization and in-network status in writing.
Questions to ask your urologist
- 01
What are the downsides of Aquablation?
The main one is bleeding: because it removes tissue with water rather than heat, vessels are not sealed as it goes, so a small number of men need a transfusion. Temporary blood in the urine, irritative urinary symptoms while healing, and urinary tract infection are also possible. Long-term durability data is still maturing.
- 02
Is Aquablation better than TURP?
Neither is universally better. Aquablation works across a wider range of prostate sizes and tends to preserve ejaculation better than TURP, while TURP is more widely available with longer-term track record. The trade-off is that Aquablation can have more bleeding. The right choice depends on your prostate size and priorities.
- 03
Does Aquablation preserve sexual function?
It is designed to spare the areas linked to ejaculation, and studies show it preserves ejaculation better than TURP. Erectile function is generally maintained as well. No prostate procedure guarantees this, so discuss your specific priorities with your urologist.
- 04
How long does Aquablation last?
Early and medium-term results for symptom relief are strong, but Aquablation is newer than TURP, so very long-term durability data is still maturing. Ask your surgeon what current outcomes and retreatment rates look like for your prostate size.
- 05
Who is not a candidate for Aquablation?
Men who are not fit for anesthesia, or who specifically want an office-based or non-surgical option, may be better served by another approach. Other causes of symptoms should be ruled out first, and men on blood thinners or with bleeding tendencies need a careful, individualized discussion because of the bleeding profile.
- 06
What does Aquablation cost?
It depends on the hospital and anesthesia setting, your prostate size, and your insurance. Coverage for symptomatic BPH is common but less universal than for TURP, and travel to a center that offers it can add to the real cost. Confirm pre-authorization and ask for a written estimate.
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New Jersey appointment path
Ask a urologist whether Aquablation fits your prostate size and goals
Start with the practice directly. Do not send sensitive medical details through public forms; the office can move the conversation into the right intake process.