Aquablation with AquaBeam for Treatment of Enlarged Prostate Symptoms: Robotic Treatment of Enlarged Prostate

by Alex Shteynshlyuger MD

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What is Aquablation Therapy for Treatment of BPH – WaterJet Ablation Therapy for Enlarged Prostate

Aquablation refers to a new approach to removing obstructive prostate tissue through the use of high-velocity saline (saline is essentially water with some minerals).   Aquablation is a surgical procedure designed to replicate the efficacy of TURP or prostate enucleation using waterjet ablation therapy.    

How is Aquablation for Treatment of Enlarged Prostate Performed?

Aquablation is performed by a urologist in the operating room under general anesthesia.  The procedure is performed with ultrasound guidance by performing a transrectal ultrasound of the prostate.  Transrectal ultrasound maps the prostate anatomy which is then fed into the AquaBeam surgical robotic planning system.  The urologist besides which area of the prostate to treat.  Cystoscopy is performed and the Aquablation delivery device is positioned within the prostate through the cystoscope. Robotically guided delivery of high velocity heated saline

How Does Aquablation Compare to Laser Enucleation of Prostate?

There have been no direct studies comparing Aquablation using the AquaBeam system to laser enucleation of the prostate.  It appears that Aquablation results in similar outcomes as TURP.  Based on indirect comparisons, most studies suggest that prostate enucleation, especially for large prostates, result in superior long-term outcomes compared to TURP.  It is possible that AquaBeam Robotically guided waterjet ablation therapy for BPH using aquablation achieves similar outcomes to laser enucleation of the prostate.

What are the Risks of Aquablation?

Post-aquablation it appears that it is difficult to pinpoint the source of bleeding and cauterization can sometimes be challenging.  Some patients require an inpatient stay with continuous bladder irrigation (CBI) or balloon tamponade of the prostatic area to stop bleeding.  This is also a risk with TURP but with modern TURP methods with direct visual control of bleeding during the procedure it is rare to require balloon tamponade of the prostate.

What are the Advantages of Aquablation?

ProCept Aquablation AquaBeam System does not generate much heat which limits potential injury to periprostatic nerves that can occur with traditional TURP procedure.  Heat injury is a suspected cause of occasional erection problems in men after TURP.   There is probably no significant advantage of Aquablation compared to Bi-polar TURP and laser prostate enucleation in terms of heat degeneration.  Prostate enucleation using Holmium laser, for example, is very precise in terms of heat generation and heat is delivered to the area of less than a millimeter at a time, which is under the surgeon’s control.

Aquablation is fast with the surgical time of fewer than 5 minutes however total time that is required to perform the procedure including ultrasound generation is similar to TURP with about 30-35 minutes based on the results of the aqua study, a randomized controlled study comparing Aquablation using an Aquabeam surgical planning system to traditional TURP.

Aquablation results in improved quality of life, improved urine flow and improved urinary frequency and urgency symptoms, similar to what is achieved with TURP.

The Water Study, a randomized control trial of Aquablation and TURP showed that urinary symptoms significantly decrease (lower is better) from 23 to 6 (improvement by 70%).   Urine flow is also significantly improved with the maximum flow of 21 ml per second from 6 (higher is better, stronger urine stream).   Similarly, residual urine volume decreases from 97 ml to 50 ml with both TURP and Aquablation, a good improvement.

Aquablation seems to preserve ejaculatory function in most men. 

Why Choose New York Urology Specialists for Treatment of Urinary Retention Caused by Enlarged Prostate?

  • All treatment is performed by a Board-certified urologist experienced in treating men with symptoms of BPH using medical therapy, minimally invasive therapies, lasers and open surgery.
  • We are one of the few practices in the region to offer a full range of options for treatment of BPH.
  • We offer BPH treatment options under local anesthesia which avoids the risks, costs, and recovery from general anesthesia. Most men are able to return to office work and other normal activities the next day.
  • Extensive Experience: Hundreds of men treated successfully using medical therapy, Urolift, lasers for BPH (Holmium, Thulium, Evolve, Greenlight lasers), Bipolar TURP, traditional TURP, open suprapubic prostatectomy, robotic suprapubic prostatectomy for BPH.
  • We treat men with BPH who have heart problems (hypertension, CAD, CHF), renal failure (ESRD) on hemodialysis, men on blood thinners such as aspirin, Lovenox, Coumadin (Warfarin), apixaban, rivaroxaban (Xarelto).

Excellence-Urology_Care VasectomyWhen it comes to experience and innovation – New York Urology Specialists are a step ahead.  Better Science Means Better Care.  We specialize in minimally invasive highly effective treatment for symptoms of enlarged prostate and BPH. Many treatment procedures are performed in the convenience and privacy of office settings under local anesthesia.

If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4044


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Schedule an Appointment with Dr. Shteynshlyuger:

Call today: 646-663-4044 or make an appointment online

Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urinary problems in men.  He uses modern effective and proven treatment methods including prostate enucleation and Urolift for BPH.  He is highly recommended by top primary care physicians in the New York area.

He has successfully performed hundreds of prostate procedures in adults. Urolift procedures are performed in the office under local anesthesia, in a surgical center and affiliated hospitals under anesthesia.

If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to Contact Us with any questions.


If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: (646) 663-4044

We offer affordable, highest-quality urology care with or without insurance.   Find out our office hours or directions to our office. We offer weekday, weekend, and evening office hours.