Benign prostatic hyperplasia (BPH) significantly impacts quality of life (QoL) through bothersome lower urinary tract symptoms (LUTS)[1]. Aquablation therapy, a minimally invasive, robot-assisted surgical modality employing a heat-free water jet, has demonstrated promising outcomes in prior clinical trials[2,3]. This study evaluates the short-term safety and efficacy outcomes of Aquablation therapy in the first prospective cohort from the region.

Prospective data were collected from all men who underwent Aquablation for symptomatic BPH at our institution from July 2024 to March 2025. The inclusion criteria were patients presenting with symptomatic BPH suitable for Aquablation treatment. Clinical data collected included demographic characteristics, baseline prostate-specific antigen (PSA), prostate volume, International Prostate Symptom Score (IPSS), medication use, and intraoperative parameters (procedure duration, complications). Short-term postoperative outcomes included Clavien-Dindo classification of complications, requirement for blood transfusion, re-treatment rates, preservation of sexual function and continence, Foley catheter duration, and hospital length of stay. Preoperative and postoperative assessments at 6 weeks included uroflowmetry (Q_max) and postvoid residual volume (PVR).

Twenty-two male patients (mean age: 64.4 ± 6.0 years; mean prostate volume 77.10 ± 24.61 cc (mean ± SD)) underwent Aquablation therapy. The cohort included 22.7% diabetics, a preoperative mean PSA of 4.13 ± 3.02 ng/mL, and a mean baseline IPSS of 12±2.3. The mean total operative time was 107 ± 34 minutes.  The mean Foley catheter duration was 2.85 ± 1.58 days (range: 1.21–8.00 days), and the mean hospital length of stay was 2.78 ± 1.08 days (range: 1.42–5.58 days). Two patients (9.1%) experienced postoperative complications classified as Clavien-Dindo Grade IIIb; one required cystoscopic clot evacuation and control of bleeder, and another underwent a bladder neck incision for management of bladder neck contracture. No other significant perioperative complications were noted, and importantly, none of the patients required perioperative blood transfusion. Ejaculatory functions and continence remained preserved. 95.2% remained off prostate medications postoperatively. At 6-week follow-up, mean Q_max significantly improved from 9.14 ± 4.35 mL/s preoperatively to 14.88 ± 5.00 mL/s (p= < 0.05), and mean PVR significantly decreased from 191.78 ± 188.44 mL preoperatively to 79.22 ± 127.13 mL postoperatively (p= <0.05).

Aquablation resulted in marked short-term improvements in urinary flow rates and bladder emptying in men with symptomatic BPH. The procedure was associated with minimal morbidity and no transfusion requirements. The findings highlight preserved sexual function and continence, while the short Foley catheter duration and hospital stay underscore Aquablation's minimally invasive recovery profile.

Aquablation therapy demonstrated favorable short-term outcomes in this region, with statistically significant improvements in uroflow parameters and postvoid residual volumes in the first few weeks following surgery. The procedure exhibited a low complication profile and a high rate of preservation of ejaculatory function. This study supports Aquablation as a safe and effective minimally invasive surgical option for BPH management. Longer-term follow-up and larger cohorts are warranted to validate these promising outcomes further.

Scholtz DJ, Hooshyari A, Vermeulen LP, et al. Aquablation: An overview of a novel, minimally invasive surgical modality to treat benign prostatic hyperplasia. Urological Science. 2024;35(1):e000001.
Gilling P, Barber N, Bidair M, et al. WATER: A double-blind, randomized, controlled trial of aquablation versus transurethral resection of the prostate in benign prostatic hyperplasia. J Urol. 2018;199(5):1252-1261.
Desai M, Bidair M, Bhojani N, 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(1):143-153.