Current Bladder Dysfunction Reports

, Volume 13, Issue 1, pp 1–7 | Cite as

The Aquabeam System: a Review

  • Marie Adrianne Pimentel
  • Omid Yassaie
  • Peter J. Gilling
BPH-Related Voiding Dysfunction (R Lee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on BPH-Related Voiding Dysfunction


Purpose of Review

The purpose of this review is to provide a description of the Aquabeam system, the technique more commonly known as aquablation, and review the literature to date including select results from the unpublished WATER study to assess the efficacy and safety of this novel technique for the treatment of male lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO).

Recent Findings

Promising outcomes from initial pilot studies and early clinical studies confirming safety and feasibility have led to the large international multi-centre randomised controlled study known as the WATER study. This compared the Aquabeam system to the current gold standard, transurethral resection of the prostate (TURP). This landmark trial has proven that aquablation equals TURP in clinical efficacy and has superior safety outcomes, particularly for larger prostates.


Aquablation is not only a technically feasible and safe procedure for symptomatic male BOO, but has equivalent efficacy to TURP with a better safety profile. Ongoing trials are taking place to confirm aquablation’s role in the spectrum of minimally invasive treatments for male LUTS.


Benign prostatic hyperplasia Aquablation Ablation techniques Minimally invasive surgical procedures Transurethral resection of the prostate 


Compliance with Ethical Standards

Conflict of Interest

Peter J. Gilling was a consultant to Procept Biorobotics prior to the WATER trial. M. Adrianne Pimentel and Omid Yassaie each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306–14. Discussion 1314–5. Scholar
  2. 2.
    Roehrborn CG. Current medical therapies for men with lower urinary tract symptoms and benign prostatic hyperplasia: achievements and limitations. Rev Urol. 2008;10(1):14.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67(6):1066–96. Scholar
  4. 4.
    • Gilling P, Reuther R, Kahokehr A, Fraundorfer M. Aquablation–image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience. BJU Int. 2016;117(6):923–9. The initial patient series of Aquablation confirming safety and early efficacy. CrossRefPubMedGoogle Scholar
  5. 5.
    MacRae C, Gilling P. How I do it: aquablation of the prostate using the AQUABEAM system. Can J Urol. 2016;23(6):8590–3.PubMedGoogle Scholar
  6. 6.
    Aljuri N, Gilling P, Roehrborn C. How I do it: balloon tamponade of prostatic fossa following Aquablation. Can J Urol. 2017;24(4):8937–40.PubMedGoogle Scholar
  7. 7.
    Papachristou DN, Barters R. Resection of the liver with a water jet. Br J Surg. 1982;69(2):93–4. Scholar
  8. 8.
    Baer HU, Stain SC, Guastella T, Maddern GJ, Blumgart LH. Hepatic resection using a water jet dissector. HPB Surg. 1993;6(3):189–96; discussion 96-8. Scholar
  9. 9.
    Nagele U, Kugler M, Nicklas A, et al. Waterjet hydrodissection: first experiences and short-term outcomes of a novel approach to bladder tumor resection. World J Urol. 2011;29:423–7.CrossRefPubMedGoogle Scholar
  10. 10.
    •• Faber K, de Abreu AL, Ramos P, Aljuri N, Mantri S, Gill I, et al. Image-guided robot-assisted prostate ablation using water jet-hydrodissection: initial study of a novel technology for benign prostatic hyperplasia. J Endourol. 2015;29(1):63–9. Proof of concept of Aquablation with early animal data. This set the stage for subsequent human trials. CrossRefPubMedGoogle Scholar
  11. 11.
    Desai M, Laddha A, Azhar RA, et al. Mp3-03 Image Guided Robotic Waterjet Ablation (Aquablation) Of The Prostate: Clinical Experience Of A Novel Technology For BPH. J Urol. 2015;4(193):e20. (Abstract)CrossRefGoogle Scholar
  12. 12.
    Anderson P, Mantri S, Aljuri N. Early clinical experience in Melbourne of a novel treatment for BPH: aquablation-image guided robotic waterjet ablation of the prostate. BJU Int. 2015;115:44–5. (Abstract)CrossRefGoogle Scholar
  13. 13.
    • Gilling P, Anderson P, Tan A. Aquablation of the prostate for symptomatic benign prostatic hyperplasia: 1-year results. J Urol. 2017;197.6:1565–72. Medium term results from a multi-centre trial. This trial involved new generations of the Aquablation and was pivotal in the evolution of the technique. CrossRefGoogle Scholar
  14. 14.
    Roehrborn CG, Gilling P. PNFLBA-03 The water study clinical results–a phase iii blinded randomized parallel group trial of aquablation vs. transurethral resection of the prostate with blinded outcome assessment for moderate-to-severe luts in men with benign prostatic hyperplasia. J Urol. 2017;197.4:e603–4. (Abstract)CrossRefGoogle Scholar
  15. 15.
    Clinical Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue II (WATERII). NCT03123250. Available from URL: Accessed 21 October 2017.
  16. 16.
    Clinical Global Post-Market Registry Using Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue (OPEN WATER). NCT02974751. Available from URL: Accessed 21 October 2017.
  17. 17.
    Tregunna RL, Cathcart P, Bultitude MF. One strategy does not fit all: the era of personalised medicine for the treatment of male lower urinary tract symptoms is upon us. Eur Urol. 2017;72(6):998–9. Scholar
  18. 18.
    Chung ASJ, Woo HH. Update on minimally invasive surgery and benign prostatic hyperplasia. Asian J Urol. 2017;5(1):22–7. Scholar
  19. 19.
    Christidis D, et al. Minimally invasive surgical therapies for BPH: the rise in MIST. Prostate Int. 2017; 5(2):41–6.Google Scholar
  20. 20.
    Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58(3):384–97. Scholar
  21. 21.
    Nair SM, Pimentel MA, Gilling PJ. Evolving and investigational therapies for benign prostatic hyperplasia. Can J Urol. 2015;22(Suppl 1):S82–7.Google Scholar
  22. 22.
    Pimentel MA, Nair SM, Gilling PJ. Aquablation™: early clinical results. Curr Bladder Dysfunct Rep. 2016;11(2):130–3. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Marie Adrianne Pimentel
    • 1
  • Omid Yassaie
    • 2
  • Peter J. Gilling
    • 3
  1. 1.Waikato HospitalHamiltonNew Zealand
  2. 2.Department of UrologyTauranga Public HospitalTaurangaNew Zealand
  3. 3.Clinical SchoolTaurangaNew Zealand

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