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Aquablation — Robotic Waterjet System

Aquablation uses a high-velocity sterile-saline jet to remove prostatic tissue under imaging guidance. The surgeon defines and monitors treatment; the system does not independently select the appropriate resection. The June 2026 AQUABEAM clearance describes user-controlled motor motion and adjustable flow. Waterjet resection is nonthermal, but the complete operation may include a separate hemostatic technique.[1]

For patient selection, planning and operative details, see Aquablation.

Device and Indication​

The AQUABEAM system includes a console, conformal planning unit, motorpack, foot pedal, transurethral handpiece and scope, with supports for the handpiece and TRUS probe. Check the actual platform and current instructions; AQUABEAM and newer HYDROS configurations should not be assumed to have identical hardware.[1]

The FDA indication is resection and removal of prostate tissue in males with LUTS due to BPH. Trial gland-size ranges and professional-guideline selection criteria are separate from that label. A short resection phase is not the entire operating time, and neither time nor the number of treatment passes is independent of gland size and anatomy.[1][2][3]

Evidence Relevant to Device Counseling​

StudyWhat it establishes
WATER, 181 randomized participants, 30–80 mL glandsAquablation met the prespecified six-month symptom noninferiority endpoint versus TURP. At five years, mean IPSS improvement was 15.1 versus 13.2 points, without a significant overall between-group difference. Ejaculatory dysfunction was less frequent with Aquablation, but was not eliminated.[2][4]
WATER II, 101 treated participants, 80–150 mL glandsProspective single-arm follow-up reported durable symptom improvement and 96.3% Kaplan–Meier freedom from a secondary BPH procedure at five years. It was not a randomized comparison against simple prostatectomy or HoLEP.[5]

Bleeding control remains part of the operation. Early WATER II reported six perioperative transfusions among 101 men. That historical protocol should not supply a current universal complication rate, and neither a nonthermal waterjet nor a revised hemostasis protocol guarantees transfusion avoidance.[3]

See also UroLift, Rezūm, iTind and Optilume BPH.

References​

1. FDA. AQUABEAM Robotic System, K253211. June 23, 2026. Clearance, indications and device summary.

2. Gilling P, Barber N, Bidair M, et al. "WATER: a double-blind, randomized, controlled trial of Aquablation vs transurethral resection of the prostate in benign prostatic hyperplasia." J Urol. 2018;199(5):1252–61. doi:10.1016/j.juro.2017.12.065

3. Desai M, Bidair M, Bhojani N, et al. "WATER II (80–150 mL) procedural outcomes." BJU Int. 2019;123(1):106–12. doi:10.1111/bju.14360

4. Gilling PJ, Barber N, Bidair M, et al. Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind, randomized trial in men with LUTS due to BPH. Can J Urol. 2022;29:10960–10968. PMID:35150215.

5. Bhojani N, Bidair M, Kramolowsky E, et al. Aquablation Therapy in Large Prostates (80–150 mL) for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: Final WATER II 5-Year Clinical Trial Results. J Urol. 2023;210:143–153. doi:10.1097/JU.0000000000003483.