Aquablation vs. TURP: What Is the Difference?
Aquablation and transurethral resection of the prostate (TURP) are surgical treatments for urinary symptoms caused by benign prostate enlargement, also known as benign prostatic hyperplasia or BPH. Both procedures are performed through the urethra without an external surgical incision. Their purpose is to remove prostate tissue obstructing the flow of urine, but they use different technologies and have different potential advantages, limitations and side-effect profiles.
Neither procedure is automatically the better choice for every patient. The decision should consider prostate size and anatomy, symptom severity, previous treatment, general health, priorities concerning ejaculation and the experience available at the treating hospital.
What Is Aquablation?
Aquablation uses a robotically controlled, high-pressure waterjet to remove obstructing prostate tissue. The surgeon plans the treatment using real-time ultrasound imaging and controls the procedure throughout. The waterjet removes tissue without using heat for the principal tissue-removal phase. However, heat or another method may subsequently be used to control bleeding, so Aquablation should not be described as an entirely heat-free operation.
A urinary catheter is normally inserted at the end of the procedure. Some patients can leave hospital on the same day, while others remain overnight or require a longer stay depending on their recovery and individual circumstances. Patients who would like a broader overview of the procedure can read more about Aquablation surgery for benign prostate enlargement.
What Is TURP?
TURP stands for transurethral resection of the prostate. It is a well-established operation that has been used for many years to treat urinary obstruction caused by an enlarged prostate. During TURP, the surgeon passes a resectoscope through the urethra. An electrical loop removes obstructing prostate tissue in small pieces and seals blood vessels as the operation progresses.
The removed tissue is usually collected and sent to the pathology laboratory for microscopic examination. A urinary catheter is left temporarily after the procedure, and the duration of admission depends on bleeding, catheter requirements and recovery.
How Do the Procedures Differ?
The principal difference concerns how the obstructing tissue is removed. Aquablation uses an ultrasound-planned, robotically controlled waterjet. TURP uses an electrical resection loop operated directly by the surgeon. The robotic system used during Aquablation does not make clinical decisions or perform the operation independently. The surgeon defines the treatment area, supervises tissue removal and manages bleeding. TURP does not rely on robotic guidance. The surgeon removes the obstructing tissue progressively while viewing the prostate through the resectoscope.
Both operations are performed through the urethra and are intended to create a wider channel for urine to pass through.
Is One Treatment More Effective?
Both Aquablation and TURP can produce meaningful improvements in urinary symptoms and urinary flow in appropriately selected patients.
TURP has a long clinical history and remains an established reference treatment for benign prostate obstruction. Aquablation is a newer procedure, although clinical studies and UK guidance support its use for selected patients. The expected result depends on more than the name of the operation. Prostate size and configuration, bladder function, the degree of obstruction and the presence of other urinary conditions can all affect the outcome.
Prostate Size and Anatomy
TURP is commonly used for small and moderately enlarged prostates. Conventionally, a prostate volume of approximately 80 cc is considered the upper threshold for TURP, although this is not an absolute limit and may depend on the equipment, technique and surgeon’s experience.
Aquablation can be considered across a range of prostate sizes, including selected prostates larger than 80 cc. Real-time ultrasound allows the surgeon to plan treatment according to the individual shape of the prostate and the position of the obstructing tissue.
Prostate size alone should not determine treatment. The presence of a median lobe, previous prostate surgery, bleeding risk, bladder function and alternative procedures such as HoLEP should also be considered.
Ejaculation and Sexual Function
Changes in ejaculation are an important consideration when comparing treatments for an enlarged prostate. Retrograde ejaculation, sometimes described as a dry orgasm, is common after TURP. This occurs when semen passes backwards into the bladder rather than leaving through the urethra. It is not usually harmful, but it can affect fertility and may be important to the patient.
Aquablation may offer a greater possibility of preserving antegrade ejaculation in selected patients because treatment can be planned to avoid certain structures involved in ejaculation. Preservation cannot be guaranteed, and the individual likelihood should be discussed before surgery. Erectile dysfunction is not the same as retrograde ejaculation. Erectile function is usually preserved following either procedure, but changes can occur and individual risks should be reviewed during consent.
Bleeding and Other Risks
Both procedures can cause bleeding, urinary infection, temporary difficulty passing urine, discomfort, urinary urgency and the need for a catheter. Blood in the urine can continue intermittently during recovery. Aquablation removes tissue using a waterjet, but bleeding still needs to be assessed and controlled during the operation. TURP uses electrical energy both to remove tissue and control bleeding.
Less common complications of either operation can include persistent urinary symptoms, urethral narrowing, bladder-neck narrowing, urinary incontinence or the need for further treatment. The frequency and relevance of these risks depend on the individual patient and the procedure being considered.
Hospital Stay and Catheter
Aquablation may be performed as a day-case procedure or with an overnight stay. Some patients may go home with a catheter for a short period. TURP commonly requires a short hospital stay while the urine clears and the catheter is managed, although practice varies between hospitals and patients. The catheter duration and discharge date cannot always be predicted before surgery. These decisions depend on bleeding, the ability to pass urine, general health and recovery from the anaesthetic.
Recovery After Aquablation or TURP
Recovery varies between patients. After either procedure, temporary burning, urinary frequency, urgency and blood in the urine may occur while the urinary tract heals. Gentle walking is generally encouraged, but strenuous exercise and heavy lifting should be avoided until the surgical team advises that they can be resumed. The timing of returning to work depends on the operation, recovery and the physical demands of the patient’s occupation.
Patients should follow the individual discharge instructions provided after surgery, as these take priority over general recovery estimates. For more detailed information about catheter care, activity restrictions, driving and returning to work, read what to expect during recovery after Aquablation.
Does the Removed Tissue Undergo Laboratory Analysis?
During TURP, the removed prostate fragments are routinely collected and sent for histological examination. This can occasionally identify an unexpected abnormality.
Aquablation removes most of the obstructing tissue using a high-pressure waterjet, so it does not generally provide the same quantity of intact tissue as TURP. However, at the end of the procedure, some residual prostate tissue is normally resected and collected. This tissue is sent for histological examination. Aquablation can therefore provide a specimen for analysis, although usually in a smaller quantity than TURP.
Neither Aquablation nor TURP is intended to treat prostate cancer. A raised PSA, abnormal examination, suspicious MRI or other concern about cancer should be investigated appropriately before an operation for presumed benign prostate enlargement.
Which Procedure May Be More Suitable for Me?
The choice should be made following an individual urological assessment. Important considerations include the severity and pattern of symptoms, prostate size and anatomy, urinary-flow measurements, residual urine, medication history, bladder function, bleeding risk and general health.
The importance of preserving ejaculation should be discussed explicitly. Patients should also understand the surgeon’s experience with each procedure, the treatment alternatives and the possibility of requiring further intervention in the future.
In some cases, TURP or Aquablation may not be the most appropriate option. Alternatives can include continued medication, HoLEP, Rezūm, UroLift, prostate artery embolisation or another surgical treatment.
Aquablation Consultations in Northampton and London
Dr Carlo Bravi offers private consultations in Northampton and London for men experiencing urinary symptoms or considering surgery for benign prostate enlargement.
The assessment may include a review of symptoms, medication, PSA results, prostate imaging, urinary-flow tests and any previous treatment. The purpose is to determine whether Aquablation, TURP or another approach may be appropriate. Further information about suitability, potential benefits, risks and the treatment pathway is available on the Aquablation surgery page.
Initial assessment and follow-up can be provided in Northampton. When Aquablation is recommended, the procedure is undertaken privately at The Wellington Hospital in London.
Learn more about Aquablation surgery and patient assessment or treatments for prostate enlargement.
Frequently Asked Questions
Is Aquablation better than TURP?
Not for every patient. Both procedures can improve urinary symptoms, but their suitability depends on prostate anatomy, general health, treatment priorities and other individual factors.
Is Aquablation performed without heat?
The waterjet removes prostate tissue without heat. However, thermal energy or another technique may be used afterwards to control bleeding.
Which procedure is more likely to preserve ejaculation?
Aquablation may have a lower risk of ejaculatory dysfunction in selected patients. Preservation is not guaranteed and should be discussed individually.
Will I need a catheter?
A temporary urinary catheter is normally required after either procedure. How long it remains in place depends on the operation and recovery.
Can either operation treat prostate cancer?
No. Aquablation and TURP relieve obstruction caused by benign prostate enlargement; they are not curative treatments for prostate cancer.
Clinical Sources and Further Information
Written by Dr Carlo Bravi, Consultant Urological Surgeon.
This article provides general information and does not replace individual medical advice.
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