Aquablation for Benign Prostatic Hyperplasia - A Prospective Study - Comparative Analysis with TURP and HoLEP

Oct 18, 2026

Benign prostatic hyperplasia drives lower urinary tract symptoms in aging men, and surgery is needed when medical therapy fails. This prospective study compared Aquablation against transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in patients with bladder outlet obstruction. Outcomes were assessed with validated symptom and function scores, with complications graded using Clavien-Dindo classification across follow-ups at 3, 6, and 12 months.

LanguageEnglish

CategoryHealthcare

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Pages7

Reading Time18 min

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Abstract

Introduction

Methods and Materials

Results

Conclusion

Keywords

Introduction

Materials and Methods

JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 36, Number 1, 2026 ª Mary Ann Liebert (NY), LLC DOI: 10.1177/10926429251393894 Aquablation for Benign Prostatic Hyperplasia: A Prospective Study with Comparative Analysis of Transurethral Resection of the Prostate and Holmium Laser Enucleation Dolev Perez, 1 Ariel Mamber, 1 Michael Pasherstnik, 1 Dmitry Koulikov, 1 Ala Eddin Natsheh, 1 Ofer Z. Shenfeld, 1 Ilan Z. Kafka, 1 Adam Hen, 1 Andres Malinger, 1 Avital Zeldin, 1 Abd Shabaneh, 1 Saeed Qadan, 1 Israel A. Ostrovsky,2 and Boris Chertin 1 Abstract Introduction: Benign prostatic hyperplasia is a leading cause of lower urinary tract symptoms in aging men. When medical therapy fails, surgery is indicated. This study evaluates the safety and efﬁcacy of Aquablation compared with transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP) in patients with bladder outlet obstruction. Methods and Materials: A prospective analysis of 318 Aquablation patients (2023–2025) was conducted and compared with 83 TURP and 83 HoLEP patients from a retrospective database. Functional outcomes were assessed using International Prostate Symptom Score (IPSS), ICIQ-UI, EF-IIEF, and MSHQ-EJD SF. Complications were graded using the Clavien-Dindo classiﬁcation. Follow-ups were performed at 3, 6, and 12 months. Results: Aquablation patients had larger prostates than TURP (94 versus 54.7 cc; P < .0001) but smaller than HoLEP (105 cc; P = .002) patients. More Aquablation patients had indwelling catheters and were on anticoagulants (P < .0001) . IPSS improvement was the greatest in Aquablation (18.9 points) versus TURP (13.8) and HoLEP (14.7; P = .000) . Erectile function was preserved in Aquablation (P = .859), with signiﬁcantly better ejaculatory function (82.8% preserved) than TURP (36%) and HoLEP (18%) . Furthermore, Clavien-Dindo grade 1–2 complications were higher in Aquablation, but serious events (CD 3–4) were comparable. Complication rates declined signiﬁcantly after the ﬁrst 30 Aquablation cases. Conclusion: Aquablation is an effective surgical option for medium to large prostates, offering superior symptom relief and preservation of sexual function. Although its learning curve is shorter than HoLEP’s, proper training is essential to minimize early complications. Keywords: Aquablation, benign prostatic hyperplasia, bladder outlet obstruction, TURP Introduction Benign prostatic hyperplasia (BPH) is a common, age related condition affecting the prostate, leading to lower urinary tract symptoms (LUTS) like a weak stream, urgency, and nocturia.1–3 Treatment options include lifestyle changes, medications (e.g., alpha-blockers and 5-alpha reductase inhibitors), and surgery.4 Medications can cause side effects, such as dizziness and sexual dysfunction, and may become ineffective over time, necessitating surgical intervention.5 Surgical choices depend on prostate size and symptom severity.6 Transurethral resection of the prostate (TURP) is the standard for prostates <80 cc but carries risks like bleeding and retrograde ejaculation.7 For larger prostates (>80 cc), options include simple prostatectomy (SPP), Holmium laser enucleation of the prostate (HoLEP), and photoselective vaporization of the prostate (PVP) . Each of these procedures presents challenges: SPP requires abdominal access and is associated with more extended hospitalization, prolonged catheterization, and a higher risk of bleeding (including the need for transfusion) . HoLEP has a steep learning curve, while PVP is more costly.8 Given these challenges, new ablative techniques have emerged as promising alternatives. In 2018, Aquablation (AquaBeam􀀂 System, PROCEPT BioRobotics, Redwood City, CA, USA) received approval from the U.S. Food and Drug Administration, offering hope for a more effective and less invasive surgical approach.9 Aquablation uses integrated real-time ultrasound imaging combined with 1The

FAQs

What condition does the study focus on and why is surgery required?

The study focuses on benign prostatic hyperplasia, which commonly causes lower urinary tract symptoms in aging men. When medical therapy fails or is not desired, surgical intervention is indicated.

How was Aquablation compared with TURP and HoLEP?

A prospective cohort of 318 Aquablation patients (2023–2025) was compared with 83 TURP and 83 HoLEP patients from a retrospectively maintained database. Functional outcomes used IPSS, ICIQ-UI, EF-IIEF, and MSHQ-EJD SF, and complications were graded with Clavien-Dindo.

What were the main findings regarding symptoms, sexual function, and complications?

Aquablation showed the greatest improvement in IPSS, with better ejaculatory function and preserved erectile function. Although early mild-to-moderate complications (Clavien-Dindo grade 1–2) were higher, serious events (CD 3–4) were comparable, and complication rates declined after the first 30 Aquablation cases.

Oct 18, 2026

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