Aquablation shows promise for treating enlarged prostates while preserving sexual function
Results from WATER III trial presented at EAU25 suggests that waterjet surgery may offer men relief from BPH symptoms without compromising ejaculatory function.
New study results presented at EAU25 in Madrid highlighted the potential of aquablation - a high-pressure waterjet surgery - for treating men with large prostates affected by benign prostatic hyperplasia (BPH). The technique appears to deliver comparable urinary outcomes to standard laser surgery, with a significantly lower risk of retrograde ejaculation, a common side effect that can affect sexual satisfaction.
The findings come from the WATER III trial, led by Prof. Manuel Ritter of the University Hospital Bonn. The trial enrolled 202 men with large prostates (80–180 mL), comparing aquablation therapy with conventional laser surgeries such as Holmium laser enucleation (HoLEP) and Thulium laser enucleation (ThuLEP).
Aquablation vs. laser surgery: What the data shows
While short-term results for symptom relief were similar across both groups, the difference in sexual side effects was notable. Among sexually active participants, only 15% in the aquablation group experienced retrograde ejaculation, compared to 77% in the laser surgery group. Urinary incontinence was also less frequent with aquablation (9%) than with laser treatments (20%).
“These patients are very happy to get rid of their medication and symptoms,” said Prof. Ritter. “The fact that aquablation also preserves ejaculatory function offers clear advantages for those who wish to maintain their sex lives after surgery.”
Expert Insights from EAU25
Prof. Cosimo De Nunzio (IT) discussed the findings on EAUTV during EAU25: “Retrograde ejaculation is a major concern for many men undergoing BPH treatment. Aquablation presents a promising option, especially for those prioritising sexual function. However, we must acknowledge the short three-month follow-up and the need for further research into long-term outcomes and additional patient groups.”
Aquablation, which uses robotic assistance and real-time ultrasound imaging, has previously been shown to reduce sexual side effects in smaller prostates. The WATER III trial is the first to demonstrate its benefits for larger prostates, potentially expanding treatment access and shortening waiting times.