News | Aquablation Shows Benefits for Enlarged Prostate: Preserved Sexual Function and Fewer Side Effects
A recent study presented at the 2025 European Association of Urology (EAU) Congress found that Aquablation, a waterjet procedure for benign prostatic hyperplasia (BPH), was as effective as laser surgery while substantially reducing ejaculatory dysfunction. The findings suggest it may be a safer, preferable alternative.
Aquablation is a minimally invasive technique that uses a high-pressure waterjet, robotic navigation, and ultrasound guidance to precisely remove excess prostate tissue. The WATER III trial is the first to confirm its safety and effectiveness for **large prostates (80 to 180 milliliters)** and compare it with standard laser procedures (HoLEP or ThuLEP).
Led by the University of Bonn in Germany, the trial involved several medical centers in Germany and the United Kingdom and enrolled 202 men undergoing BPH surgery. Of these, 98 received Aquablation and 88 underwent laser surgery.
At the three-month follow-up, researchers assessed retrograde ejaculation, urinary incontinence, and improvement in urinary symptoms using the International Prostate Symptom Score (IPSS). The results showed:
Among 89 sexually active men, retrograde ejaculation occurred in only 15% of those who received Aquablation, compared with 77% in the laser surgery group
Urinary incontinence occurred in 9% of the Aquablation group and 20% of the laser surgery group
Both groups achieved similar improvements in urinary symptoms and had similar rates of postoperative adverse events
Professor Manuel Ritter, director of urology at University Hospital Bonn and lead investigator, said: “Aquablation is an important advance for men who want to preserve sexual function while treating BPH. Many patients can also stop relying on long-term medication after surgery, significantly improving their quality of life.”
He added that Aquablation has a shorter learning curve than laser surgery and can be used more broadly, allowing precise and safe removal even in large prostates.
Benign prostatic hyperplasia is one of the most common prostate conditions worldwide. Its prevalence increases with age, affecting more than half of men over 50 and over 80% of those over 70. Although benign, it often causes frequent urination, difficulty urinating, and a weak urinary stream, substantially affecting quality of life.
Common surgical options include transurethral resection of the prostate (TURP) and laser enucleation, but both frequently cause side effects such as retrograde ejaculation and erectile dysfunction. A previous five-year study also found that Aquablation markedly reduced retrograde ejaculation compared with TURP.
Commenting on the study, Professor Cosimo De Nunzio, associate professor of urology at Sapienza University of Rome and a member of the EAU Congress Scientific Committee, said: “Preserving sexual pleasure and ejaculatory function while improving urinary symptoms has always been a challenge in BPH treatment. Aquablation offers a very encouraging answer.”
He cautioned that follow-up remains short at only three months. Future studies should examine longer-term outcomes and include more high-risk patients, such as those with chronic urinary retention or indwelling catheters. Changes in prostate-specific antigen (PSA) and improvements in urinary flow should also be priorities for further research.
The WATER III study was funded by PROCEPT BioRobotics, the developer of Aquablation technology, and sponsored by the University of Bonn.
News | Aquablation Shows Benefits for Enlarged Prostate: Preserved Sexual Function and Fewer Side Effects
News | Aquablation Shows Benefits for Enlarged Prostate: Preserved Sexual Function and Fewer Side Effects
A recent study presented at the 2025 European Association of Urology (EAU) Congress found that Aquablation, a waterjet procedure for benign prostatic hyperplasia (BPH), was as effective as laser surgery while substantially reducing ejaculatory dysfunction. The findings suggest it may be a safer, preferable alternative.
Aquablation is a minimally invasive technique that uses a high-pressure waterjet, robotic navigation, and ultrasound guidance to precisely remove excess prostate tissue. The WATER III trial is the first to confirm its safety and effectiveness for **large prostates (80 to 180 milliliters)** and compare it with standard laser procedures (HoLEP or ThuLEP).
Led by the University of Bonn in Germany, the trial involved several medical centers in Germany and the United Kingdom and enrolled 202 men undergoing BPH surgery. Of these, 98 received Aquablation and 88 underwent laser surgery.
At the three-month follow-up, researchers assessed retrograde ejaculation, urinary incontinence, and improvement in urinary symptoms using the International Prostate Symptom Score (IPSS). The results showed:
Among 89 sexually active men, retrograde ejaculation occurred in only 15% of those who received Aquablation, compared with 77% in the laser surgery group
Urinary incontinence occurred in 9% of the Aquablation group and 20% of the laser surgery group
Both groups achieved similar improvements in urinary symptoms and had similar rates of postoperative adverse events
Professor Manuel Ritter, director of urology at University Hospital Bonn and lead investigator, said: “Aquablation is an important advance for men who want to preserve sexual function while treating BPH. Many patients can also stop relying on long-term medication after surgery, significantly improving their quality of life.”
He added that Aquablation has a shorter learning curve than laser surgery and can be used more broadly, allowing precise and safe removal even in large prostates.
Benign prostatic hyperplasia is one of the most common prostate conditions worldwide. Its prevalence increases with age, affecting more than half of men over 50 and over 80% of those over 70. Although benign, it often causes frequent urination, difficulty urinating, and a weak urinary stream, substantially affecting quality of life.
Common surgical options include transurethral resection of the prostate (TURP) and laser enucleation, but both frequently cause side effects such as retrograde ejaculation and erectile dysfunction. A previous five-year study also found that Aquablation markedly reduced retrograde ejaculation compared with TURP.
Commenting on the study, Professor Cosimo De Nunzio, associate professor of urology at Sapienza University of Rome and a member of the EAU Congress Scientific Committee, said: “Preserving sexual pleasure and ejaculatory function while improving urinary symptoms has always been a challenge in BPH treatment. Aquablation offers a very encouraging answer.”
He cautioned that follow-up remains short at only three months. Future studies should examine longer-term outcomes and include more high-risk patients, such as those with chronic urinary retention or indwelling catheters. Changes in prostate-specific antigen (PSA) and improvements in urinary flow should also be priorities for further research.
The WATER III study was funded by PROCEPT BioRobotics, the developer of Aquablation technology, and sponsored by the University of Bonn.
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