Written and Medically Reviewed by Mr Ivo Dukic, Consultant Urologist | Last updated: 25/02/2026

Aquablation Therapy for Enlarged Prostate in Birmingham

NICE-approved robotic prostate surgery at The Harborne Hospital, HCA Healthcare

Revolutionary robotic Aquablation therapy for an enlarged prostate (BPH) is now available at The Harborne Hospital, Birmingham. Experience minimally invasive, heat-free relief with HCA Healthcare UK.

Available at: The Harborne Hospital, Birmingham (HCA Healthcare)

Consultation fee: £300 · Appointments within 7 days

Secretary: 0121 716 9046 — Monday to Friday, 8am–6pm

Fee-assured with: BUPA · AXA PPP · Aviva · Vitality · WPA · Cigna · AIG · Aetna

The Enlarged Prostate: Breaking the Compromise

For many men over the age of 50, Benign Prostatic Hyperplasia (BPH) — commonly known as an enlarged prostate — is a frustrating and disruptive condition. Clinical BPH affects 50–75% of men over 50, rising to more than 80% in those over 70.[1]

Common symptoms include a slow urinary flow, difficulty initiating micturition, urgency, and nocturia (waking at night to void). Historically, treating BPH has involved a difficult trade-off. Medication often provides only partial or incomplete symptom relief, while traditional surgery — Transurethral Resection of the Prostate (TURP) — carries meaningful risks of sexual dysfunction, particularly retrograde ejaculation, reported in up to 65–90% of cases following TURP. [2] Now, as a consultant urologist in Birmingham, I am pleased to offer Aquablation Therapy — a significant advancement in bladder outflow obstruction management.

What is Aquablation Therapy?

Aquablation therapy is a minimally invasive surgical treatment utilising the AquaBeam Robotic System. In 2023, the National Institute for Health and Care Excellence (NICE) updated its guidance (HTG691) to recommend Aquablation under standard arrangements — its most favourable recommendation — confirming sufficient evidence for safety and efficacy in the treatment of BPH.[3] Unlike methods relying on thermal energy (laser prostatectomy) or mechanical resection (TURP), Aquablation uses a high-velocity, heat-free waterjet. By avoiding thermal energy, the risk of thermal injury to the neurovascular bundles responsible for erectile function and the musculature involved in antegrade ejaculation is significantly reduced.[4]

What Happens During Aquablation Surgery?

Before surgery

At your consultation, we will assess your prostate symptoms using validated scoring tools (IPSS), review your flow rate and post-void residual volume, and arrange prostate sizing by ultrasound or MRI if not already done. Once we have agreed that Aquablation is the right approach, surgery is planned and pre-operative blood tests are arranged.

The procedure (40–60 minutes)

Aquablation is performed under general anaesthesia. You will be asked to stop certain medications in advance — your care team will advise you specifically.

During the operation:

- A cystoscope (camera) is positioned in the urethra, and an ultrasound probe placed in the rectum, giving a real-time dual view of the entire prostate

- A personalised surgical map is created, marking the tissue to be removed and the critical structures — sphincter, ejaculatory ducts, neurovascular bundles — to be preserved

- The robotic AquaBeam system then delivers a precisely controlled, heat-free water jet that resects only the mapped tissue in under two minutes of active treatment time

- Any bleeding is controlled with brief cautery if needed; a urinary catheter is placed at the end of the procedure

After surgery

Most patients stay in hospital for one night. The catheter is typically removed after 24–48 hours. Most men return to light daily activities within one to two weeks.

Temporary recovery symptoms include:

- Burning or stinging when passing urine (up to 2 weeks, approximately 1 in 3 patients)

- Visible blood in the urine (up to 4 weeks, approximately 1 in 4 patients)

- Temporary urgency or increased frequency

- Urinary tract infection (manageable with antibiotics, approximately 1 in 5 patients)

These are expected parts of recovery and resolve as the prostate heals.

How Aquablation Works: Robot, Water, and Precision

The procedure combines two real-time imaging modalities — cystoscopy and transrectal ultrasound — orchestrated by a robotic system.

Surgical Mapping: Under anaesthesia, transrectal ultrasound provides a live, multidimensional view of the prostate. A precise computerised map of the tissue to be removed is defined, with careful avoidance of the verumontanum (essential for ejaculation) and the external urethral sphincter (critical for continence).[5]

Robotic Resection: Once the plan is confirmed, the robot executes the resection with submillimetre precision. The mean resection time in the WATER randomised controlled trial was just 4 minutes, with total operative time comparable to TURP (33 vs. 36 minutes).[6]

Haemostasis: Following tissue removal, haemostasis is achieved using balloon catheter traction, with electrocautery reserved for cases of persistent bleeding. A urinary catheter remains in situ post-operatively, typically removed within a few days.[7]

The Advantages: Why Choose Aquablation?

Supported by robust Level 1 clinical evidence from the WATER (prostates 30–80 mL) and WATER II (prostates 80–150 mL) studies, Aquablation offers durable symptom relief with a favourable safety profile.[6][7][8]

Preservation of Sexual Function: In the WATER double-blind randomised controlled trial (n=181), procedure-related ejaculatory dysfunction was significantly lower following Aquablation compared to TURP (7% vs. 25%, p=0.0004), and no new-onset erectile dysfunction was reported in either arm at 5-year follow-up.[8][4] A 2025 systematic review across 15 studies (n=1,533) confirmed antegrade ejaculation preservation rates of 72–99.6% post-Aquablation, with stable erectile function across all included studies.[9]

Consistency and Safety: Robotic execution removes operator variability, providing standardised, reproducible outcomes regardless of surgeon experience.[6] Versatility for

All Prostate Sizes: Unlike UroLift or Rezum (limited to smaller glands), Aquablation is validated for prostates from 30 mL to 150 mL, including those with an obstructive median lobe.[3][10]

NICE Approved (IPG770): NICE recommends Aquablation under standard arrangements for symptomatic BPH (IPG770), applicable to both NHS and private patients.[3]

Who is the ideal patient?

Aquablation is particularly well-suited for men who:

• Have moderate to severe lower urinary tract symptoms (International Prostate Symptom Score [IPSS] typically ≥13) not adequately controlled by medical therapy.[3]

• Have a prostate volume of 30–150 mL.[3][10]

• Are highly motivated to preserve ejaculatory and sexual function.[9]

• Are seeking a durable, long-term solution — 5-year surgical retreatment rates from the WATER trial were only 6% for Aquablation versus 12.3% for TURP.[8]

Understanding the Risks and Recovery

Temporary Recovery Symptoms (typically resolve as healing occurs):

• Dysuria/stinging on voiding: up to 2 weeks (approximately 1 in 3 patients).[8]

• Visible haematuria: may persist up to 4 weeks (approximately 1 in 4 patients).[8]

• Pelvic discomfort: typically resolves within the first few weeks (approximately 1 in 5 patients).[8] Urinary tract infection: may require antibiotic treatment (approximately 6–7%).[8]

Long-Term Risks:

• Retrograde ejaculation: significantly lower than TURP but reported in approximately 7– 10% of sexually active men at 5-year follow-up (vs. 25–36% following TURP).[8][4]

• Retreatment: surgical retreatment is required within 5 years in approximately 4% of patients (WATER II: 3.7% at 5 years by Kaplan-Meier analysis).[10]

• Urinary incontinence or urethral stricture/bladder neck contracture: very low risk, with no new long-term incontinence reported in several prospective series.[11]

For more information, please review the NHS Decision Support Tool for Enlarged Prostate

Frequently Asked Questions (FAQs)

What is Aquablation therapy and how does it work?

Aquablation therapy uses the AquaBeam Robotic System to treat an enlarged prostate (BPH). It combines real-time cystoscopy and ultrasound imaging with a robotically controlled, heat-free water jet to precisely remove obstructing prostate tissue. Because no heat is used, the risk of damage to the nerves controlling erection and ejaculation is significantly lower than with TURP or laser prostatectomy.

Is Aquablation available on the NHS in Birmingham?

Aquablation at The Harborne Hospital is currently available as a private procedure. Mr Dukic is fee-assured with all major insurers. NHS provision of Aquablation varies by trust — contact your GP for information about NHS availability in your area.

How much does Aquablation cost privately in Birmingham?

An initial consultation with Mr Dukic to assess whether Aquablation is appropriate for you costs £300. Surgical fees depend on your insurer or self-pay arrangement and are discussed transparently at your consultation. If you hold insurance with BUPA, AXA PPP, Aviva, Vitality, WPA, Cigna, AIG or Aetna, Mr Dukic is fully fee-assured. Call 0121 716 9046 for a self-pay price guide.

How long does Aquablation surgery take?

The procedure itself typically takes 40 to 60 minutes under general anaesthetic. Most patients stay in hospital for one night and have their catheter removed within 24–48 hours.

How long does it take to recover from Aquablation therapy? Most patients stay in the hospital overnight and have their catheter removed a few days later. You can generally return to light, normal activities within a few days, though you may experience mild burning or blood in your urine for 2 to 4 weeks while the prostate fully heals.

Is Aquablation better than TURP?

Aquablation delivers equivalent or superior symptom relief to TURP (IPSS improvement: -15.1 vs. -13.2 points, respectively), with a significantly lower risk of ejaculatory dysfunction and a lower surgical retreatment rate.[8][12] For men with larger prostates (≥50 mL), Aquablation demonstrated superior safety and efficacy versus TURP.[8]

Will Aquablation affect my erections?

No new-onset erectile dysfunction was reported in any arm of the WATER randomised controlled trial across 5 years of follow-up.[8][4] A 2025 systematic review confirmed stable erectile function following Aquablation across all reviewed studies.[9]

Will Aquablation affect my sexual function?

Aquablation is specifically designed to minimise the risk of sexual side effects. In the pivotal WATER clinical trial, the rate of ejaculatory dysfunction with Aquablation was 10%, compared to 37% with TURP. Erectile dysfunction and urinary incontinence rates were also low. No surgical procedure carries zero risk, and Mr Dukic will discuss realistic individual outcomes at your consultation.

What are the risks of Aquablation?

Temporary side effects during recovery include burning when passing urine (approximately 1 in 3 patients, resolving within 2 weeks), blood in the urine (approximately 1 in 4 patients, resolving within 4 weeks), and urinary tract infection (approximately 1 in 5 patients, treatable with antibiotics). Long-term serious complications — including incontinence and irreversible erectile dysfunction — occur at low rates. All risks are discussed in full at your pre-operative consultation.

Do I need a referral to discuss Aquablation privately?

No. You can self-refer for a private consultation with Mr Dukic by calling 0121 716 9046 or booking online. If you prefer, your GP can write a referral letter directly to Mr Dukic's secretary,

Restoring Your Quality of Life in Birmingham

Choosing the right surgical approach is a highly personal decision, informed by your prostate anatomy, symptom burden, and personal priorities. If you have been delaying treatment due to concerns about sexual side effects, Aquablation represents a well-evidenced option that may allow effective symptom relief while preserving the functions that matter most to you. Schedule a Consultation: Mr Ivo Dukic is a consultant urologist offering personalised consultations in Birmingham

Schedule a Consultation: Mr Ivo Dukic is an experienced consultant urologist offering private personalised consultations in Birmingham.

• Email: admin@ivodukic.co.uk

• Private Patients Telephone: 0121 716 9046 (Mon-Fri 08:00 - 18:00)

• Clinics: Harborne Hospital, HCA Healthcare, the Priory Hospital, Edgbaston, Circle Health Group or Droitwich Spa, Circle Health and The Spire Parkway Hospital, Solihull

References

1. Mo J, Fang Y, Chen Q, Wu J, Huang W, Liu X, et al. Tracking and analysis of BPH and prostate cancer burden globally: 1990–2021. Transl Androl Urol. 2024;13(1):45–57.

2. Desai M, Bidair M, Bhojani N, Trainer A, Arther A, Kramolowsky E, et al. WATER II (80–150 mL) procedural outcomes. BJU Int. 2019;123(1):106–12.

3. Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Acher P, et al. WATER: a double-blind, randomised, controlled trial of Aquablation vs transurethral resection of the prostate in benign prostatic hyperplasia. J Urol. 2018;199(5):1252–61.

4. Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Acher P, et al. Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind randomised trial in men with LUTS due to BPH. Can J Urol. 2023;30(1):11392–401.

5. Oumedjbeur K, Corsi NJ, Bouhadana D, Ibrahim A, Nguyen DD, Matta I, et al. Aquablation versus TURP: 5-year outcomes of the WATER randomized clinical trial for prostate volumes 50–80 mL. Can J Urol. 2023;30(5):11650–8.

6. Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Acher P, et al. Two-year outcomes after Aquablation compared to TURP: efficacy and ejaculatory improvements sustained. Adv Ther. 2019;36(6):1326–36.

7. Lokeshwar SD, Beksac AT, Gonzalez-Padilla DA, Klaassen Z, Ramasamy R. Ejaculatory function after robotic waterjet ablation for the treatment of BPH: a systematic review. Int J Impot Res. 2025 [Epub ahead of print].

8. National Institute for Health and Care Excellence. Transurethral water-jet ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia [IPG770]. London: NICE; 2023. Available from: https://www.nice.org.uk/guidance/ipg770

9. Schwartz RN, Couture F, Sadri I, Arezki A, Nguyen DD, Zakaria AS, et al. Which anatomic structures should be preserved during Aquablation? World J Urol. 2021;39(5):1535–41.

10. PROCEPT BioRobotics Corporation. Five-year data from the WATER II study demonstrate Aquablation therapy delivers significant durable improvement of BPH symptoms while preserving sexual function in men with large prostates [press release]. Redwood City (CA): PROCEPT BioRobotics; 2023 Apr 28.

11. International Continence Society. Novel therapies for benign prostatic obstruction: review of reported ejaculatory dysfunction in clinical trials evaluating minimally invasive treatment modalities for BPH. Bristol: ICS; 2023.

12. Complication profile and safety outcomes of Aquablation therapy: a systematic review. NCBI PMC. 2025 [Epub ahead of print].