A classic, highly effective endoscopic technique for managing moderate-to-severe benign prostatic hyperplasia (BPH). Utilizing a specialized high-definition scope inserted through the natural channel, obstructive prostatic tissue blocks are precisely shaved away layer by layer to re-establish a wide, powerful urinary stream.

Clinical Indication

This procedure is highly indicated for patients experiencing structural anomalies, severe localized scar tissue, or functional blockages that fail to resolve with initial conservative therapeutic adjustments.

Surgical Objective

The principal objective is the complete restoration of physiological form, functional urinary path independence, or mechanical integrity, maximizing long-term outcomes while minimizing systemic downtime.

Transurethral Resection of the Prostate (TURP)—specifically utilizing modern bipolar energy—remains the historical reference standard for endoscopic treatment of benign prostatic hyperplasia (BPH). In modern bipolar TURP, radiofrequency energy vaporizes and resects obstructing prostate tissue in an isotonic saline medium, eliminating the historical risk of TUR syndrome (hypotonic hyponatremia) and providing superior intraoperative hemostasis.

Clinical Indications & Patient Selection

Indicated for men with symptomatic bladder outlet obstruction from BPH with prostate volumes typically between 30 and 80 grams.

Medical Therapy Failure: Inadequate symptom relief or intolerable side effects from tamsulosin, finasteride, or alfuzosin.

Urinary Retention & High Residuals: Recurrent inability to void or progressive bladder decompensation with high post-void residuals.

Secondary Complications of BPH: Recurrent urinary tract infections, bladder stones, or prostate-source gross hematuria.

Surgical Technique & Procedural Nuance

Performed entirely through the urethra using a specialized continuous-flow bipolar resectoscope.

Bipolar Loop Resection: Controlled radiofrequency plasma loop systematically slices obstructing transition zone adenoma into small chips under clear saline irrigation.

Anatomical Landmarks: The resection begins at the bladder neck and extends distal to the surgical capsule, strictly stopping proximal to the verumontanum to safeguard continence.

Tissue Evacuation & Coagulation: Prostatic chips are evacuated using an Ellik evacuator, and point hemostasis is verified with bipolar rollerball coagulation.

Postoperative Pathway & Recovery Timeline

Most procedures are performed as same-day outpatient cases or with overnight observation.

Catheter Removal: A 3-way Foley catheter is maintained for 24 to 48 hours to gently irrigate and rest the bladder.

Post-Removal Voiding: Patients void in the clinic before discharge, noting an immediate increase in stream force.

Activity Guidelines: Avoid strenuous activity, straining, and heavy lifting for 3 weeks to prevent secondary bleeding.

Outcomes, Durability & Clinical Evidence

Bipolar TURP provides rapid, profound, and durable relief from bladder outlet obstruction.

Significant Flow Rate Increase: Urinary symptoms and flow typically improve substantially.

Track Record: Long track record; few men need a repeat procedure.

Transurethral Resection of the Prostate (TURP)—specifically utilizing modern bipolar energy—remains the historical reference standard for endoscopic treatment of benign prostatic hyperplasia (BPH). In modern bipolar TURP, radiofrequency energy vaporizes and resects obstructing prostate tissue in an isotonic saline medium, eliminating the historical risk of TUR syndrome (hypotonic hyponatremia) and providing superior intraoperative hemostasis.

Clinical Indications & Patient Selection

Indicated for men with symptomatic bladder outlet obstruction from BPH with prostate volumes typically between 30 and 80 grams.

Medical Therapy Failure: Inadequate symptom relief or intolerable side effects from tamsulosin, finasteride, or alfuzosin.

Urinary Retention & High Residuals: Recurrent inability to void or progressive bladder decompensation with high post-void residuals.

Secondary Complications of BPH: Recurrent urinary tract infections, bladder stones, or prostate-source gross hematuria.

Surgical Technique & Procedural Nuance

Performed entirely through the urethra using a specialized continuous-flow bipolar resectoscope.

Bipolar Loop Resection: Controlled radiofrequency plasma loop systematically slices obstructing transition zone adenoma into small chips under clear saline irrigation.

Anatomical Landmarks: The resection begins at the bladder neck and extends distal to the surgical capsule, strictly stopping proximal to the verumontanum to safeguard continence.

Tissue Evacuation & Coagulation: Prostatic chips are evacuated using an Ellik evacuator, and point hemostasis is verified with bipolar rollerball coagulation.

Postoperative Pathway & Recovery Timeline

Most procedures are performed as same-day outpatient cases or with overnight observation.

Catheter Removal: A 3-way Foley catheter is maintained for 24 to 48 hours to gently irrigate and rest the bladder.

Post-Removal Voiding: Patients void in the clinic before discharge, noting an immediate increase in stream force.

Activity Guidelines: Avoid strenuous activity, straining, and heavy lifting for 3 weeks to prevent secondary bleeding.

Outcomes, Durability & Clinical Evidence

Bipolar TURP provides rapid, profound, and durable relief from bladder outlet obstruction.

Significant Flow Rate Increase: Urinary symptoms and flow typically improve substantially.

Track Record: Long track record; few men need a repeat procedure.

Related Conditions & Patient Recovery Protocols

Clinical Subspecialty Hub: BPH & Advanced Voiding Therapies Hub →

Underlying Clinical Condition: Overactive Bladder →

Aquablation

Aquablation is a newer, heat-free option for the same problem. A robotic waterjet, guided by real-time ultrasound, removes the blocking prostate tissue. I offer both procedures, and the right choice depends on your prostate's size and shape and on how much you want to protect ejaculation.

An advanced, robotic-assisted, non-thermal intervention for benign prostatic hyperplasia (BPH). It combines high-fidelity real-time ultrasound imaging with an autonomous, high-velocity waterjet to precisely map and cleanly remove obstructive prostate tissue while aggressively minimizing risk to sexual function nerve structures.

Clinical Indication

This procedure is highly indicated for patients experiencing structural anomalies, severe localized scar tissue, or functional blockages that fail to resolve with initial conservative therapeutic adjustments.

Surgical Objective

The principal objective is the complete restoration of physiological form, functional urinary path independence, or mechanical integrity, maximizing long-term outcomes while minimizing systemic downtime.

Aquablation therapy is an innovative, robotically guided surgical treatment for benign prostatic hyperplasia (BPH) that uses a high-velocity, heat-free saline waterjet to resect obstructing prostate tissue. By combining real-time multi-planar transrectal ultrasound (TRUS) imaging with robotic precision, the surgeon customizes the exact resection contour on a computer screen, sparing the delicate ejaculatory ducts and external urinary sphincter.

Clinical Indications & Patient Selection

Indicated for men with moderate to severe urinary symptoms from BPH, regardless of prostate shape or size (from 30 cc to 150+ cc).

Prioritizing Sexual Function Preservation: Men who want significant relief from BPH obstruction but wish to protect erectile function and prevent retrograde ejaculation.

Complex Anatomy & Large Median Lobes: Prostates with large intravesical median lobes that extend high into the bladder base.

Prostates of Any Size: Used across a wide range of prostate sizes, including very large glands.

Surgical Technique & Procedural Nuance

Conducted under general or spinal anesthesia via transurethral robotic positioning.

Dual Ultrasound & Cystoscopic Mapping: The surgeon visualizes the prostate concurrently through transrectal ultrasound and direct transurethral camera, mapping the exact depth of the waterjet.

Ejaculatory & Sphincter Sparing: The contour boundary is drawn specifically above the verumontanum and away from the neurovascular bundles, shielding them from energy.

Robotic Waterjet Ablation: The robotic arm autonomously passes the high-velocity waterjet across the tissue, cleanly removing the adenoma in less than 5 to 7 minutes without any thermal heat spread.

Postoperative Pathway & Recovery Timeline

Patients generally stay overnight in the hospital for observational irrigation.

Catheter Removal: Catheter is removed either the following morning or on post-operative day 2.

Mild Dysuria & Bleeding: Mild burning and pink-tinged urine are common for 1 to 2 weeks as the tissue bed heals.

Rapid Recovery: Return to normal non-strenuous daily routines within 5 to 7 days.

Outcomes, Durability & Clinical Evidence

Clinical trials (WATER and WATER II) validate superior functional outcomes and exceptional safety profiles.

Ejaculatory Preservation: Ejaculation is preserved in most men, more often than with TURP or enucleation.

Erectile Function: New erection problems are rare because no heat is used.

Aquablation therapy is an innovative, robotically guided surgical treatment for benign prostatic hyperplasia (BPH) that uses a high-velocity, heat-free saline waterjet to resect obstructing prostate tissue. By combining real-time multi-planar transrectal ultrasound (TRUS) imaging with robotic precision, the surgeon customizes the exact resection contour on a computer screen, sparing the delicate ejaculatory ducts and external urinary sphincter.

Clinical Indications & Patient Selection

Indicated for men with moderate to severe urinary symptoms from BPH, regardless of prostate shape or size (from 30 cc to 150+ cc).

Prioritizing Sexual Function Preservation: Men who want significant relief from BPH obstruction but wish to protect erectile function and prevent retrograde ejaculation.

Complex Anatomy & Large Median Lobes: Prostates with large intravesical median lobes that extend high into the bladder base.

Prostates of Any Size: Used across a wide range of prostate sizes, including very large glands.

Surgical Technique & Procedural Nuance

Conducted under general or spinal anesthesia via transurethral robotic positioning.

Dual Ultrasound & Cystoscopic Mapping: The surgeon visualizes the prostate concurrently through transrectal ultrasound and direct transurethral camera, mapping the exact depth of the waterjet.

Ejaculatory & Sphincter Sparing: The contour boundary is drawn specifically above the verumontanum and away from the neurovascular bundles, shielding them from energy.

Robotic Waterjet Ablation: The robotic arm autonomously passes the high-velocity waterjet across the tissue, cleanly removing the adenoma in less than 5 to 7 minutes without any thermal heat spread.

Postoperative Pathway & Recovery Timeline

Patients generally stay overnight in the hospital for observational irrigation.

Catheter Removal: Catheter is removed either the following morning or on post-operative day 2.

Mild Dysuria & Bleeding: Mild burning and pink-tinged urine are common for 1 to 2 weeks as the tissue bed heals.

Rapid Recovery: Return to normal non-strenuous daily routines within 5 to 7 days.

Outcomes, Durability & Clinical Evidence

Clinical trials (WATER and WATER II) validate superior functional outcomes and exceptional safety profiles.

Ejaculatory Preservation: Ejaculation is preserved in most men, more often than with TURP or enucleation.

Erectile Function: New erection problems are rare because no heat is used.

Related Conditions & Patient Recovery Protocols