Who Is Suitable for Aquablation Treatment?
Aquablation may be considered for men whose urinary symptoms are caused by benign prostate enlargement and who require more than observation or medication. It may be suitable across a range of prostate sizes and anatomical configurations, but prostate size alone does not determine whether it is the right treatment.
The decision requires an individual assessment of symptoms, prostate anatomy, bladder function, previous treatment, general health and personal priorities. Some men will be better suited to Aquablation, while others may benefit more from TURP, HoLEP, medication or another treatment.
What Is Aquablation?
Aquablation is a minimally invasive surgical treatment for urinary obstruction caused by benign prostate enlargement, also known as benign prostatic hyperplasia or BPH. During the procedure, a high-pressure waterjet removes selected obstructing prostate tissue. Real-time ultrasound allows the surgeon to see the prostate and plan the area requiring treatment. The waterjet phase does not use heat, although focal cautery may be used afterwards to control bleeding.
The procedure is performed through the urethra, without an external surgical incision, and normally requires a general anaesthetic.
You can read a more detailed explanation on the Aquablation surgery page.
When May Aquablation Be Considered?
Aquablation may be considered when benign prostate enlargement is causing moderate or severe urinary symptoms that affect everyday life. These symptoms may include a weak urinary stream, difficulty starting urination, prolonged emptying, urinary frequency, urgency, waking repeatedly during the night and the sensation that the bladder has not emptied completely.
Surgery may also be discussed when medication has not provided sufficient improvement, causes unacceptable side effects or is no longer the patient’s preferred treatment. In other cases, intervention may be recommended because prostate enlargement has contributed to urinary retention, recurrent infections, bladder stones, persistent bleeding or changes affecting the bladder or kidneys. The presence of symptoms does not automatically mean that surgery is required. Their cause and severity should be assessed before deciding on treatment.
Does Prostate Size Determine Suitability?
Prostate size is important, but it should not be considered in isolation. Aquablation has been studied across a range of prostate sizes and may be considered for selected men with larger prostates. One of its practical features is that ultrasound-guided planning allows treatment to be adapted to the size and shape of the individual prostate. However, the decision also depends on where the obstructing tissue is located, whether a median lobe is present, the relationship of the prostate to surrounding structures and how much tissue needs to be removed.
For some anatomies or particularly large and complex prostates, HoLEP, another endoscopic procedure or occasionally simple prostatectomy may be more appropriate. The experience of the surgeon and the facilities available at the treating hospital are also relevant.
What Assessment Is Required Before Aquablation?
Before recommending Aquablation, the urologist should confirm that the urinary symptoms are caused predominantly by obstruction from an enlarged prostate. Assessment may include a discussion of symptoms and their effect on quality of life, medication history, physical examination, urine testing and a PSA blood test when appropriate.
Additional investigations may include uroflowmetry to measure urinary flow, measurement of the urine remaining in the bladder after voiding, ultrasound or another assessment of prostate size and anatomy, and cystoscopy in selected patients. Urodynamic testing is not required for every patient but may be useful when there is uncertainty about bladder function or the cause of the symptoms.
The purpose of these investigations is not simply to confirm that the prostate is enlarged. They help establish whether removing prostate tissue is likely to improve urination.
What Role Does Bladder Function Play?
A large prostate and urinary symptoms do not always mean that prostate obstruction is the only problem. The bladder muscle may become overactive, producing urgency and frequency, or it may become weak and unable to contract effectively. Diabetes, neurological conditions, longstanding obstruction, previous pelvic treatment and increasing age may also affect bladder function.
Aquablation can remove obstructing prostate tissue, but it cannot directly restore a bladder muscle that has become significantly weakened. Patients with impaired bladder function may still benefit in selected circumstances, but the expected improvement and possibility of persistent symptoms should be discussed carefully. This is why the treatment decision should be based on the complete assessment rather than prostate size alone.
Is Aquablation Suitable After Urinary Retention?
Aquablation may be considered for selected men who have experienced urinary retention or require a catheter because of prostate obstruction. Before proceeding, the urologist may need to assess whether the bladder is still able to contract effectively and whether another condition has contributed to the retention. Some patients may require further testing before the likely benefit of surgery can be estimated.
The possibility of voiding successfully after treatment depends on both relief of the obstruction and the underlying function of the bladder.
What If Preserving Ejaculation Is Important?
The possible effect of treatment on ejaculation is an important consideration when choosing surgery for benign prostate enlargement. Aquablation has been developed to allow individualised treatment planning and may offer a lower risk of ejaculatory dysfunction than some traditional tissue-removing operations. However, preservation of ejaculation cannot be guaranteed.
The individual probability depends on prostate anatomy, the area requiring treatment, the extent of tissue removal and the findings during surgery. Erectile dysfunction, urinary incontinence and ejaculatory changes remain recognised potential complications and should be discussed before consent. A patient who places particular importance on preserving ejaculation should mention this during consultation so that the available treatments can be compared properly.
When Might Aquablation Not Be the Best Option?
Aquablation is not automatically the best treatment for every enlarged prostate. Another approach may be preferable when urinary symptoms are not primarily caused by prostate obstruction, when bladder weakness is likely to limit improvement or when a different procedure is better suited to the prostate’s anatomy. An active urinary infection should normally be treated before surgery. Suspicion of prostate cancer may also require appropriate investigation before treatment for benign enlargement proceeds.
Anticoagulant or antiplatelet medication, bleeding risk, previous prostate or urethral surgery and the patient’s fitness for anaesthesia require individual assessment. These factors do not necessarily exclude Aquablation, but they may influence preparation, timing or the choice of procedure. Patients should also understand that surgery may improve obstruction without eliminating every symptom, particularly urgency, frequency or nocturia when these have more than one cause.
How Does Aquablation Compare With Other Treatments?
Aquablation is one of several treatments available for benign prostate enlargement. TURP removes obstructing tissue using an electrically powered instrument and remains an established surgical treatment. HoLEP uses a laser to separate obstructing prostate tissue and can be particularly useful for larger prostates. Other options include GreenLight laser treatment, Rezūm, UroLift, prostate artery embolisation and, in selected cases, simple prostatectomy.
Each treatment differs in its suitability for different prostate sizes and anatomies, likely improvement in urinary flow, recovery, bleeding risk, effect on ejaculation, availability and possibility of requiring further treatment.
You can read more in Aquablation vs TURP: What Is the Difference?.
What Questions Should I Ask During Consultation?
Useful questions include whether prostate obstruction has been confirmed, whether the bladder appears to function normally, which treatments are technically suitable and why one procedure is being recommended over another. Patients may also wish to ask about the surgeon’s experience, the expected catheter duration, likely hospital stay, recovery, risk of bleeding, possible effects on ejaculation and the probability that urinary symptoms will improve.
A balanced consultation should include both the potential advantages of Aquablation and the reasonable alternatives.
Recovery After Aquablation
Aquablation is commonly performed as a day-case procedure or with an overnight hospital stay, although this depends on the patient, the operation and local practice. A temporary urinary catheter is normally inserted. It may be removed before discharge or remain for a few days according to how the procedure went and the individual recovery.
Temporary urinary frequency, urgency, burning and blood in the urine can occur while the urinary tract heals. More precise instructions about driving, work, exercise, lifting and travel should be provided by the surgical team following the operation.
Read the detailed guide to recovery after Aquablation.
Aquablation Consultations in London and Northampton
Dr Carlo Bravi offers private consultations for men considering Aquablation or seeking advice about treatment for benign prostate enlargement. Consultations are available in London and Northampton. Assessment may include review of symptoms, medication, previous investigations, prostate size and anatomy, bladder emptying and individual treatment priorities.
Frequently Asked Questions
Is Aquablation suitable for every enlarged prostate?
No. It may be considered across a range of prostate sizes, but suitability depends on symptoms, anatomy, bladder function, previous treatment, general health and alternative procedures.
Can Aquablation be performed for a large prostate?
It may be considered for selected larger prostates. Size alone does not determine suitability, and another procedure may sometimes offer a safer or more appropriate option.
Do I need to try medication first?
Not in every circumstance. Many patients try medication before surgery, but intervention may be discussed earlier when symptoms are severe, complications have occurred or medication is unsuitable.
Can Aquablation preserve ejaculation?
Aquablation may have a lower risk of ejaculatory dysfunction than some traditional operations. Individual risk should be discussed with the surgeon.
Is Aquablation suitable if I take blood-thinning medication?
This requires individual assessment. The medication, reason for taking it and personal bleeding risk must be reviewed before deciding whether and how surgery can proceed. In many cases, anticoagulant medication is temporarily stopped before surgery and restarted shortly afterwards, once the risk of postoperative bleeding is considered acceptable.
Arrange a Consultation
If you are experiencing urinary symptoms or would like to understand whether Aquablation may be appropriate, Dr Carlo Bravi offers private urology consultations in London and Northampton.
An individual assessment can help determine whether symptoms are caused by prostate obstruction and compare Aquablation with the other reasonable treatment options.
This article provides general information and does not replace individual medical advice.
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