It’s no secret that men don’t like to go to the doctor. For men who have an enlarged prostate, a condition that can cause frequent or painful urination, playing the waiting game doesn’t help.
Advances in urology have led to the development of a newer procedure called Hydros Aquablation, or Aquablation therapy, that can help men avoid traditional surgery that may cause incontinence, changes in ejaculation and erectile dysfunction. Hydros Aquablation is innovative and helps treat an enlarged prostate, also called benign prostatic hyperplasia (BPH). Hydros Aquablation uses a heat-free waterjet tool, robotics and real-time imaging to precisely and efficiently remove enlarged prostate tissue.
Why should men address an enlarged prostate?
The prostate is a muscular gland that naturally gets larger over a man’s lifetime. When it enlarges, it places pressure on the bladder and urethra, the tube that carries urine from the bladder to the penis. This can narrow and even obstruct urine flow, causing urinary symptoms that affect quality of life
What are the symptoms of symptomatic BPH?
- Increased urinary frequency: You may wake up several times at night.
- Decrease urine flow: The flow may be weak, or it may not be easy to start urinating.
- Incomplete bladder emptying: You may feel your bladder isn’t empty even after urinating.
- Painful urination: You could feel pain after urination or ejaculation.
“BPH is a progressive disease,” Lee said. “If left untreated, symptoms can worsen and lead to severe complications such as urinary retention, bladder infections or even kidney failure. In some cases, men may even require a permanent catheter due to complete bladder failure.”
How does Hydros Aquablation work?
“Hydros Aquablation uses a heat-free waterjet, robotics and ultrasound imaging to precisely remove prostate tissue,” Lee said. “Unlike traditional methods that use heat, steam or lasers, Hydros Aquablation utilizes no thermal energy.”
Hydros Aquablation utilizes artificial intelligence (AI) and real-time imaging to map the size and shape of the opening that is created by the water jet.
“I love that I can combine AI with my surgical experience to tailor treatment to the needs of each patient,” Lee said. “Once the mapping is complete, I initiate the treatment with a foot pedal. The result is an open prostate channel similar to TURP but with so much more precision.”
Surgery typically takes 30-45 minutes, and about one-third of patients can go home the same day. Recovery includes an overnight hospital stay, and a urinary catheter is maintained for 5-7 days.
Seven advantages of Hydros Aquablation
- Lower risk of sexual side effects
- Retrograde ejaculation (dry orgasm) occurs in 65-75% of men after TURP but in less than 10% of Hydros Aquablation patients.
- Hydros Aquablation has a less than 0.5% impact on erectile function, compared to 2-3% with TURP.
- Reduced urinary complications
- Traditional TURP has an incontinence rate of 2-3%, whereas Hydros Aquablation lowers that to less than 0.5%.
- Lower risk of scar tissue
- Traditional TURP has a 5-7% risk of scarring at the bladder neck and prostate junction, while Hydros Aquablation reduces this risk to less than 0.5%.
- Suitable for most prostate size or shape
- Men with larger glands can avoid more complex surgical procedures.
- Minimally invasive
- No incisions, less pain and faster recovery.
- Precision and predictability
- Robotic technology enables precise tissue removal, reducing the complications mentioned above.
- Faster recovery
- Most patients resume normal activities within days.
What are other surgical treatments for an enlarged prostate?
Medications are often the first line of treatment for BPH. However, when medications become ineffective, surgical options may be necessary. Surgical options include:
- Bipolar transurethral resection of the prostate (TURP): The most common procedure, TURP shaves away excess prostate tissue using a heated wire loop.
- Rezum (water vapor thermal therapy, or WVTT): Uses steam to destroy prostate cells and nerves that narrow and tighten the prostate channel.
- UroLift (prostatic urethral lift or PUL): Uses implants that are surgically placed to hold the enlarged prostate away from the urethra to help relieve symptoms.
- Laser surgery (PVP, HoLAP, HoLEP): Uses lasers to remove excess prostate tissue.
- Robotic simple prostatectomy: This robotic-assisted procedure is reserved for men with very large prostate glands. It removes only the inner portion of the prostate to relieve symptoms while minimizing side effects. In contrast, robotic radical prostatectomy involves the complete removal of the prostate and is performed to treat prostate cancer.
All these procedures require general or spinal anesthesia. Although some procedures can be done as an out-patient, most of the above-mentioned procedures require a one- to two-day stay in the hospital and a catheter for one to seven days.
Does insurance cover Hydros Aquablation?
Most private insurers cover Hydros Aquablation for patients who meet BPH surgical criteria. While Medicare and Medicaid is expected to expand in January 2026, most men already qualify.
The future of BPH treatment
“For years, men have avoided surgery due to horror stories about complications,” Lee said. “Now, with Hydros Aquablation, men who have struggled in silence finally have a safe and effective solution that restores their quality of life.”
UCHealth Urology offers a full range of BPH treatments, but Hydros Aquablation is emerging as one of the most promising options.
“This is the surgical treatment for BPH that I’ve been waiting for my whole career,” said Lee, a urologist with over 20 years of experience.
Lee said if you or a loved one is struggling with BPH, consult a urologist to discuss your options and find the best treatment for your needs.