If you have been diagnosed with an enlarged prostate and are considering surgery, you are likely worried about three things:
- Bleeding and safety
- Whether your prostate is “too big”
- Long-term side effects
These concerns are entirely valid. Traditional prostate surgery has historically been associated with bleeding, longer recovery, and higher risk in men with large prostates.
Aquablation surgery has emerged as a modern alternative designed to reduce these risks. In December 2025, the strongest real-world evidence to date was published in BJU International, analysing outcomes from more than 70,000 men worldwide.
What Is an Enlarged Prostate (BPH), and Why Does It Get Worse With Age?
The prostate is a small gland that sits below the bladder and surrounds the urethra, the tube that drains urine. With age, hormonal changes cause the prostate to grow.
This condition is called benign prostatic hyperplasia (BPH).
“Benign” means non-cancerous, but the symptoms can still be severe.
By the age of:
- 50 → around 40% of men have BPH
- 60 → around 50–60%
- 80 → more than 80%
As the prostate enlarges, it squeezes the urethra, leading to lower urinary tract symptoms (LUTS). LUTS refers to problems with urination.
What Urinary Symptoms Are Caused by an Enlarged Prostate?
Common symptoms include:
- Weak or slow urine stream
- Difficulty starting urination
- Stopping and starting during urination
- Feeling the bladder does not empty fully
- Frequent urination
- Waking at night to urinate (nocturia)
- Sudden urgency
These symptoms often worsen over time. Poor bladder emptying can also lead to infections, bladder stones, and long-term bladder damage.
When Do Tablets Stop Being Enough for BPH?
Many men start with medication, such as:
- Alpha-blockers (relax the prostate muscle)
- 5-alpha reductase inhibitors (shrink the prostate slowly)
While tablets help many patients, studies show that 30–40% of men either do not experience sufficient improvement or stop taking the medication due to side effects such as dizziness, tiredness, or sexual problems.
When symptoms disrupt sleep, work, or daily life, surgery offers the most reliable long-term relief.
Why Are Men So Worried About Prostate Surgery?
Most fears relate to older surgical techniques.
Traditional prostate operations can be associated with:
- Significant bleeding
- Blood transfusion
- Longer hospital stay
- Higher risk in large prostates
- Sexual side effects
Bleeding risk is significant. It increases with:
- Larger prostates
- Longer operating time
- Heat-based tissue removal
This is where Aquablation differs.
What Is Aquablation Surgery? (Clear, Patient Explanation)
Aquablation is a minimally invasive, robot-assisted operation for BPH.
Instead of using heat, laser, or electric current, Aquablation removes prostate tissue using a high-pressure jet of sterile water, guided by real-time ultrasound imaging.
In simple terms:
- The surgeon maps the prostate using ultrasound
- The area causing the blockage is carefully planned
- A robotic system delivers a precise water jet
- Only the obstructing tissue is removed
No burning. No cutting with heat.
Why Does Avoiding Heat Matter in Prostate Surgery?
Heat damages tissue beyond the target area. This can:
- Injure blood vessels (increasing bleeding)
- Damage nerves
- Affect ejaculation and continence
Aquablation avoids thermal injury. This is a key reason for its success in preventing erectile issues.
What Makes Aquablation Different From Older Prostate Operations?
Aquablation combines three critical elements:
- Ultrasound imaging – the prostate is visualised in real time
- Robotic precision – consistent tissue removal
- Surgeon planning – human judgement with robotic execution
This combination reduces variability and improves safety.
Why Is the 2025 BJU International Study So Important?
Earlier Aquablation studies were clinical trials. Trials are helpful, but they involve selected patients under ideal conditions.
The 2025 BJU International study analysed real-world data:
- 70,270 Aquablation procedures
- Over 6 years
- Multiple countries and healthcare systems
- Every day patients, not “perfect trial candidates”
For patients, this answers the most critical question: What actually occurs in practice?
How Large Were the Prostates Treated With Aquablation in Real Life?
This is one of the most powerful findings of the study.
Prostate size data:
- Average prostate size: 87 mL
- Very large prostates included: up to 1,189 mL
For context:
- Normal prostate: 20–30 mL (size of a walnut)
- Many traditional surgeries become more difficult above 80–100 mL
This study confirms Aquablation is used safely across the full spectrum, including very large prostates.
What Is the Risk of Serious Bleeding After Aquablation?
Bleeding was measured using meaningful outcomes:
- Blood transfusion
- Return to the theatre to control bleeding
The result:
0.2% serious bleeding rate
That means:
- 2 men out of every 1,000
- Across all prostate sizes
- Across tens of thousands of patients
This is an exceptionally low figure for prostate surgery.
Does Prostate Size Increase Bleeding Risk With Aquablation?
With older techniques, yes.
With Aquablation, this study shows:
- Bleeding risk remained low and consistent
- Even in very large prostates
- No sharp rise in complications with size
The Aquablation study directly challenges the belief that “big prostates mean dangerous surgery”.
Why Is Bleeding Lower With Aquablation?
Several reasons:
- No heat damage to blood vessels
- Highly accurate treatment planning
- Short, controlled tissue removal time
- Robotic consistency reduces surgical variation
All of these minimise trauma and blood loss.
What Urinary Improvements Can Patients Expect After Aquablation?
Aquablation removes the physical blockage, allowing the bladder to empty more easily.
Patients commonly experience:
- Stronger urine stream
- Less straining
- Fewer nighttime trips to the toilet
- Reduced urgency and frequency
- Better bladder emptying
Clinical studies consistently show significant improvements in IPSS (International Prostate Symptom Score) and quality-of-life measures.
How Long Is Recovery After Aquablation?
Recovery varies, but typically:
- Hospital stay: daycase or overnight stay
- Temporary catheter for a short period
- Mild burning or blood in urine settles over days to weeks
Avoiding heat injury may help reduce inflammation and speed recovery.
Who Is Aquablation Best Suited For?
Aquablation may be particularly suitable for men who:
- Have moderate to severe urinary symptoms
- Have large or very large prostates
- Are concerned about bleeding risks
- Want a modern, image-guided operation
Final suitability depends on prostate anatomy and overall health.
Frequently Asked Questions About Aquablation Surgery for Enlarged Prostate (BPH)
What is Aquablation surgery for an enlarged prostate?
Aquablation is a minimally invasive surgical treatment for benign prostatic hyperplasia (BPH). It uses a robot-controlled high-pressure water jet guided by real-time ultrasound to remove prostate tissue that blocks urine flow. It does not use heat, lasers, or electrical energy.
Is Aquablation surgery safe?
Yes. The most extensive real-world study published in BJU International in 2025 analysed over 70,000 Aquablation procedures and found a serious bleeding rate of only 0.2%, meaning just 2 in every 1,000 men required a blood transfusion or return to theatre for bleeding control.
Does Aquablation cause less bleeding than traditional prostate surgery?
Real-world data show Aquablation has very low major bleeding rates, even in men with large prostates. This is partly because Aquablation avoids heat, which can damage blood vessels during traditional prostate surgery.
Can Aquablation be used for large or very large prostates?
Yes. The 2025 BJUI study included prostates ranging from small to extremely large, with some over 1,000 mL in size. Bleeding risk remained low across all prostate sizes, showing Aquablation is suitable even for very large prostates.
Is my prostate too big for Aquablation surgery?
In most cases, no. Unlike some traditional techniques that become more complex as prostate size increases, Aquablation is used safely across a wide range of prostate sizes in real-world practice.
How does Aquablation improve urinary symptoms?
Aquablation removes the part of the prostate that blocks the urethra. This improves urinary flow and reduces symptoms such as a weak stream, difficulty initiating urination, frequent urination, urgency, and nocturia.
How long does it take to recover from Aquablation surgery?
Most patients stay in the hospital overnight, or the procedure can be performed as a day case. A temporary catheter is usually required. Mild burning or blood in the urine is common initially and typically improves over days to weeks.
Does Aquablation affect sexual function?
Because Aquablation avoids heat and is highly precise, studies have shown lower rates of sexual side effects compared with some traditional prostate operations. Individual outcomes can vary depending on anatomy and baseline function.
Is Aquablation better than TURP?
Aquablation and TURP (transurethral resection of the prostate) are both effective treatments for BPH. However, Aquablation offers robotic precision, avoids heat injury, and has demonstrated very low serious bleeding rates for men with larger prostates.
Is Aquablation a permanent solution for BPH?
Aquablation removes obstructing prostate tissue and provides long-lasting symptom relief for many men. As with all BPH treatments, long-term outcomes depend on individual factors and prostate biology.
Is Aquablation new or experimental?
No. Aquablation has been in clinical use for several years and is supported by extensive international studies, including one of the largest real-world safety datasets ever published for prostate surgery.
Why Aquablation Is Changing Enlarged Prostate Surgery
Based on the largest real-world dataset available:
- Used across all prostate sizes
- Serious bleeding rate of 0.2%
- Consistent outcomes in everyday practice
- Combines imaging, robotics, and precision
For men worried about bleeding and safety, especially those with large prostates, Aquablation represents a significant step forward.
Aquablation Surgery for Enlarged Prostate: Key Patient Takeaway
Aquablation offers a modern, precise approach to enlarged prostate surgery with exceptionally low serious bleeding rates, even in very large prostates. Real-world evidence now strongly supports its role as one of the safest surgical options available for BPH.
