Aquablation is a relatively new, minimally invasive surgical technique developed to treat benign prostatic hyperplasia (BPH). The procedure uses a robotically guided, high-pressure water jet, operating at room temperature, to precisely remove obstructive prostate tissue. This method relies on real-time imaging to create a customized treatment map, aiming to preserve structures associated with sexual function and continence. While this approach offers many benefits, particularly for men with larger prostates, patients must fully understand the drawbacks, risks, and limitations before making a treatment decision.
Immediate Surgical Complications
The primary concern following Aquablation is the risk of significant bleeding, related to the nature of tissue removal. Unlike procedures that use electricity or heat, the water jet does not cauterize blood vessels as it removes tissue, requiring a separate step for hemostasis. The potential for hemorrhage is particularly pronounced in patients with larger prostate volumes, such as those exceeding 80 grams.
While the reported rate of major bleeding requiring a blood transfusion is generally low, around 3.3% in some real-world studies, post-treatment control of bleeding remains a consideration. Urologists typically manage this by using electrocautery applied to the prostatic capsule or by employing temporary catheter traction. The possibility of internal injury to surrounding structures, such as the urethra or bladder, also exists, though it is infrequent due to the system’s precise robotic guidance.
The procedure is performed in a hospital setting and requires either general or spinal anesthesia, which introduces a separate set of risks related to anesthesia itself. Although Aquablation is noted for its low rates of sexual side effects compared to older methods, it does not eliminate them entirely. Retrograde ejaculation, where semen flows backward into the bladder, is a recognized complication, occurring in roughly 6.9% of patients in clinical trials.
The precision of the robotic system aims to avoid the nerves responsible for ejaculation, but the mechanical removal of tissue can still affect the bladder neck’s function. Another common immediate complication is the development of a urinary tract infection (UTI) in the first month following the operation, which has been reported in approximately 11.2% of men. These immediate health risks require close monitoring.
Post-Procedure Recovery Burdens
Following the Aquablation procedure, patients must manage the recovery period. Nearly all patients wake up with a temporary urinary catheter, which is necessary to manage initial bleeding and swelling within the prostatic fossa. The catheter is used for continuous bladder irrigation to flush out blood clots and tissue debris, and it remains in place until the urine is visibly clear.
Though the goal is often to remove the catheter before hospital discharge, some patients may need to go home with the device for a few days if they are unable to urinate effectively on their own. This extended catheter dependence is a source of discomfort, restricts mobility, and increases the risk of infection. A typical hospital stay of at least one night is required for observation and post-operative care.
Once the catheter is removed, patients frequently experience a cluster of irritative voiding symptoms that can persist for several weeks. These symptoms include a burning sensation during urination, urinary urgency, and increased frequency. Such discomfort occurs as the bladder and urethra adjust to the newly created, open channel through the prostate.
While most patients can resume light, non-strenuous activities within one to two weeks, the full resolution of these temporary urinary annoyances can take longer. Patients must avoid heavy lifting or intense physical activity for up to a month to prevent increased bleeding.
Limitations on Suitability and Accessibility
Aquablation presents certain structural and systemic limitations that can affect a patient’s decision-making process. The procedure requires the use of specialized robotic equipment and a dedicated operating room setup. This reliance on advanced technology means that Aquablation is not yet universally available, limiting access for patients in rural or less-specialized healthcare settings.
The financial aspect of the treatment is a significant limitation. The overall cost of Aquablation is frequently higher than that of established, older alternatives like Transurethral Resection of the Prostate (TURP). This higher cost can translate into challenges with insurance approval or higher out-of-pocket expenses for some patients.
The relative scarcity of extensive long-term data is a constraint. While five-year follow-up data from randomized trials demonstrate sustained efficacy and durability, data extending beyond this period is still accumulating. The absence of 10-year or 15-year outcomes means that the true long-term retreatment rates and durability of the procedure compared to the most established treatments are not yet fully understood.
While the procedure is effective for a wide range of prostate sizes, some insurance providers may limit coverage based on age. This can arbitrarily restrict access for older men who may have the largest prostate volumes and therefore stand to benefit significantly from the therapy.