Aquablation

How Aquablation works

Under general or spinal anaesthesia, a dual-imaging probe is passed into the rectum and a specialised handpiece is placed in the prostatic urethra. The surgeon maps the target volume on a computer console. The robotic system then delivers the high-pressure saline waterjet in a pre-planned pattern while the patient is kept still. The actual ablation takes only a few minutes. Any small bleeding at the end of the procedure is typically managed with endoscopic coagulation or a compression balloon catheter.

Who Aquablation suits

• Men with a prostate between 30 and 150 cc, where the equipment is available.
• Men who particularly value a short ablation time.
• Men who may wish to preserve antegrade ejaculation (preservation rates are higher than after TURP or HoLEP in published series, though not as high as with UroLift or iTind).

Aquablation vs HoLEP

• Mechanism. Aquablation ablates with a waterjet under robotic control; HoLEP enucleates with a laser under direct vision.
• Size range. Both scale well through large prostates; HoLEP has published series in glands above 200 cc.¹⁰
• Bleeding. Aquablation is heat-free, so vessel sealing depends on subsequent coagulation or a compression balloon. HoLEP seals vessels during the cut.
• Durability. Aquablation has 5-year randomised data showing symptom maintenance; HoLEP has 10-year data with low retreatment rates.⁸
• Availability. Aquablation requires a capital-intensive robotic platform. Not yet universally available in Sydney.