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Aquablation — AquaBeam Robotic Waterjet System

Aquablation (Procept BioRobotics) uses a robotically controlled high-velocity saline waterjet to perform heat-free hydroablation of prostatic tissue under real-time transrectal-ultrasound (TRUS) guidance. The console plans the resection contour intraoperatively from the TRUS image; the robotic handpiece then delivers the waterjet through a transurethral sheath, ablating the planned volume in ~ 5 minutes regardless of prostate size.[1][2]

For procedural detail see Aquablation.

Device Components​

  • AquaBeam console with TRUS-integrated planning interface.
  • Robotic handpiece with articulated waterjet nozzle delivering saline at supersonic velocity through a transurethral 24 Fr sheath.
  • TRUS probe providing real-time biplanar imaging for contour planning.
  • Cystoscope for direct visualization at planning and post-resection steps.

Indications​

  • BPH-related LUTS across a wider prostate-volume range than other MIST options (30–150 mL), including large glands typically directed to HoLEP or open simple prostatectomy.[3]
  • FDA-approved 2017; CE-marked 2014.
  • Patients who prioritize ejaculation preservation (substantially better than TURP in WATER trial when the bladder-neck region is spared during planning).[4]

Reconstructive Relevance​

  • Hemostasis is the principal historical concern: the waterjet itself is non-thermal and does not coagulate vessels — early protocols used focal cautery + catheter traction for bladder-neck hemostasis post-ablation. Modern protocols have reduced transfusion rates from ~ 5% to ~ 1%.[5]
  • Long-term outcomes (WATER 5-yr): IPSS reduction sustained ~ 14 points; surgical retreatment 3.4% at 5 yr.[5]
  • WATER II large-prostate cohort: comparable efficacy to historical simple-prostatectomy benchmarks for 80–150 mL glands.[3]
  • Cross-links: UroLift, Rezūm, iTind, Optilume BPH DCB.

References​

1. Gilling P, Reuther R, Kahokehr A, Fraundorfer M. "Aquablation — image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience." BJU Int. 2016;117(6):923–9. doi:10.1111/bju.13358

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. Nguyen DD, Barber N, Bidair M, et al. "Comparing aquablation and transurethral resection of the prostate: 3-year results of the WATER randomized controlled trial." Urology. 2021;150:48–54. doi:10.1016/j.urology.2020.05.115

5. Bach T, Giannakis I, Bachmann A, et al. "Aquablation of the prostate: single-center results of a non-selected, consecutive patient cohort." World J Urol. 2019;37(7):1369–75. doi:10.1007/s00345-018-2509-y