What is Retzius-sparing robotic prostatectomy and why does it matter?

The Retzius-sparing (posterior) approach preserves the anatomical structures at the front of the bladder that are critical for early urinary continence. In traditional robotic prostatectomy, these are divided. By going behind the bladder instead, Mr Ameen achieves continence recovery that is typically 4–6 weeks faster than the standard approach. Most of his patients are pad-free or using one small pad within 4–6 weeks of catheter removal.

How long will I be in hospital after a robotic prostatectomy?

Most patients stay 1–2 nights. You will wake up with a urinary catheter in place, which is removed at approximately 10 days at a follow-up clinic. You'll be walking the same day as surgery. Most men return to light activities within 2 weeks and full activity including exercise by 6–8 weeks.

Do I need a GP referral to see Mr Torath Ameen privately?

No. You can book a private consultation directly without a GP referral. However, a referral letter and any previous test results or imaging will be very helpful to the consultation. If your insurer requires a GP referral for reimbursement, please check their policy before booking.

How quickly can I get an appointment with Mr Ameen?

Private consultation appointments are typically available within 1–2 weeks. For urgent cases (visible haematuria, rapidly rising PSA, suspected cancer), please call directly on 0204 558 6750 and a priority appointment will be arranged. Mr Ameen personally reviews all urgent referrals.

Does an elevated PSA mean I have prostate cancer?

No. PSA can be elevated for several reasons including a large benign prostate (BPH), prostatitis or inflammation, recent ejaculation or vigorous exercise, or urinary tract infection. However, an elevated PSA does need careful evaluation by a specialist. Mr Ameen will interpret your PSA in the context of your age, prostate size, symptoms and family history before recommending any further investigation.

Do I always need my whole kidney removed for kidney cancer?

Not always. For tumours smaller than 4–7 cm, a partial nephrectomy — removing only the tumour and preserving the rest of the kidney — is often possible and is the preferred option to protect long-term kidney function. Mr Ameen performs robotic partial nephrectomy for eligible tumours, achieving cancer control rates equivalent to total removal while preserving kidney function.

What is the difference between Aquablation and TURP for prostate enlargement?

TURP (transurethral resection of the prostate) uses heat energy to remove prostate tissue and is the established gold standard. Aquablation uses a robotically-guided high-pressure waterjet, which is inherently cool and removes tissue without heat. This means significantly lower rates of retrograde ejaculation (dry orgasm) — approximately 10% versus 65–90% for TURP — making it particularly suitable for sexually active men. Both achieve similar improvements in urinary symptoms.

Which private health insurers does Mr Torath Ameen accept?

Mr Ameen is recognised by Bupa, AXA Health, Aviva and most other major UK private health insurers. Please confirm your policy details and any authorisation requirements directly with your insurer prior to booking. Self-pay patients are also very welcome at transparent fixed prices.

Where does Mr Torath Ameen practice in London?

Mr Ameen sees private patients at three locations: the Wellington Hospital in St John's Wood (NW8), 9 Harley Street in Marylebone (W1G), and Chase Lodge Hospital in London. He also holds an NHS consultant post at West Hertfordshire Teaching Hospitals NHS Trust (Watford General Hospital), accessible via NHS e-Referral.

Will I be incontinent after robotic prostatectomy?

Some degree of urinary leakage is common in the first few weeks after catheter removal. With the Retzius-sparing technique, the majority of Mr Ameen's patients achieve social continence (pad-free or one small pad) within 4–6 weeks. Pelvic floor exercises started before surgery significantly improve recovery. The vast majority of patients are fully continent at 12 months.

Is laser always better than TURP?

No. Both can be excellent when appropriately selected and expertly performed.

Which surgery is best for a very large prostate?

Enucleation procedures or simple prostatectomy may be considered, depending on anatomy, availability and expertise.

Which procedure best preserves ejaculation?

Some minimally invasive options have higher ejaculation-preservation rates, but suitability and durability vary.

Does prostate surgery cause incontinence?

Temporary urgency or leakage can occur; persistent stress incontinence is uncommon but possible, with risk varying by procedure and patient.

Will BPH surgery lower PSA?

Removing benign tissue often lowers PSA, but ongoing prostate-cancer risk assessment may still be needed.

Aquablation for Enlarged Prostate | Mr Torath Ameen London

Quick answer

Aquablation uses a robotically-guided, ultrasound-mapped high-pressure waterjet to remove obstructing prostate tissue without heat. It is NICE-approved in the UK, produces symptom improvements comparable to TURP, and has a significantly lower rate of retrograde ejaculation — making it particularly suited to sexually active men with benign prostate enlargement.

Benign prostate enlargement (BPH) is one of the most common conditions affecting men over 50 — and the range of surgical treatments has expanded considerably. Aquablation is among the newer options, approved by NICE in 2020 and now available at selected centres across the UK, including London. For the right patient, it offers a compelling combination: symptom improvement comparable to the traditional gold standard, with a significantly lower risk of affecting ejaculation.

What is Aquablation?

Aquablation uses the AQUABEAM Robotic System — a combination of real-time ultrasound imaging and a robotically-controlled high-pressure waterjet — to remove obstructing prostate tissue. Unlike TURP, which uses an electrified loop and generates heat, the waterjet is inherently cool. The absence of thermal energy is the key difference: heat is responsible for much of the nerve damage that causes retrograde ejaculation in conventional surgery.

The procedure is performed under general or spinal anaesthesia. Before the waterjet is activated, the urologist maps the prostate in detail using ultrasound, defining precisely which tissue should be removed and which structures to protect. The robotic arm then executes the planned resection automatically, guided by that map.

Key fact

Aquablation received NICE approval in the UK in 2020 (technology appraisal TA593). The WATER and WATER II clinical trials demonstrated symptom improvement equivalent to TURP, with retrograde ejaculation rates of approximately 10% versus 65–90% for TURP.

How is it different from TURP?

TURP — transurethral resection of the prostate — uses an electrically heated loop to cut and remove tissue. It is highly effective and has decades of outcome data behind it. The trade-off is that the heat used inevitably damages the ejaculatory ducts and nearby nerves, resulting in retrograde ejaculation (dry orgasm) in the majority of men.

Aquablation removes tissue mechanically rather than thermally. Because no heat is involved, the nerves controlling ejaculation are far less likely to be damaged. This does not mean there is zero risk — but the difference in published rates is substantial.

Aquablation retrograde ejaculation rate: approximately 10% (WATER trial)
TURP retrograde ejaculation rate: approximately 65–90%
Symptom improvement (IPSS score reduction): broadly equivalent between the two
Aquablation works across a wider range of prostate sizes — up to approximately 150cc
The robotic guidance removes operator-to-operator variability in resection depth

Who is Aquablation suited to?

Aquablation tends to be discussed with men who meet most of the following:

Diagnosed BPH causing bothersome urinary symptoms not controlled by medication
Sexually active and wishing to preserve ejaculatory function
Prostate volume between 30 and 150cc
Fit for general or spinal anaesthesia
No previous pelvic radiotherapy or major bladder neck surgery

It is not automatically the right choice for every man with BPH. Men with very small prostates, those who have already experienced retrograde ejaculation, or those for whom a shorter procedure under local anaesthetic is preferable may be better served by Rezūm, UroLift or other options.

What happens on the day?

The procedure is carried out in an operating theatre under general or spinal anaesthesia and takes approximately 30–60 minutes, depending on prostate size. Key steps are:

A transrectal ultrasound probe is used to image the prostate in real time
The surgeon maps the prostate on screen, defining the treatment zone and marking structures to protect
The AQUABEAM system delivers a precisely controlled waterjet that removes the mapped tissue
A catheter is placed at the end of the procedure to allow the urethra to heal

Most men stay in hospital for one to two nights. The catheter is typically removed within 24–48 hours, compared with several days for TURP — this is one reason recovery after Aquablation tends to feel more comfortable in the immediate period.

Recovery — what to expect

Recovery is broadly similar to other endoscopic BPH procedures. Most men notice improved urinary flow within the first few weeks, though temporary urgency, frequency and occasional bleeding in the urine can occur during the healing phase.

Days 1–2: catheter in situ, light activity only, some urinary burning normal
Week 1–2: catheter removed, urinary frequency and urgency common as tissue heals
Weeks 3–6: urinary symptoms typically settle; most men see clear improvement
3 months: most men have reached their best functional outcome
Return to driving: usually 1–2 weeks; return to work (desk-based) 1–2 weeks
Strenuous exercise and sexual activity: typically 4–6 weeks

Is Aquablation available on the NHS?

NICE approved Aquablation in 2020 (TA593), but NHS availability in the UK remains limited to centres that have invested in the AQUABEAM system. Access varies significantly by trust. Privately, it is available at a smaller number of specialist units. If you are considering Aquablation, it is worth asking specifically whether your consultant is trained in and has direct access to the system — not all urologists offering BPH treatment have this.

Questions worth asking at your consultation

What is my prostate volume and does it fall within the Aquablation range?
Am I a suitable candidate based on my anatomy and bladder function?
What is your personal experience with Aquablation — how many have you performed?
How does my risk of retrograde ejaculation compare between Aquablation and TURP for my specific case?
Are there reasons TURP, HoLEP or Rezūm might be more appropriate for me?
What is the re-treatment rate and what would happen if symptoms returned?

Frequently asked questions

Is Aquablation painful?

The procedure itself is done under general or spinal anaesthesia, so there is no pain during surgery. Afterwards, most men experience some burning or discomfort when passing urine for a week or two, and urinary urgency is common during the healing phase. This is similar to other BPH procedures and typically settles within a few weeks.

Will Aquablation affect my erections?

Erectile function is largely preserved after Aquablation. The main sexual side effect is retrograde ejaculation (dry orgasm), which occurs in approximately 10% of cases — significantly less than TURP. Erectile dysfunction is an uncommon complication of any BPH surgery and is not specific to Aquablation.

How long do the results last?

Medium-term follow-up data (3–5 years) shows durable symptom improvement comparable to TURP. Longer-term data is still being collected as the procedure is relatively new. As with all BPH treatments, some men may require retreatment over time as the prostate continues to grow.

Can I have Aquablation if I have a very large prostate?

Yes — one of Aquablation's advantages over TURP is that it is effective across a wider range of prostate sizes, up to approximately 150cc. The WATER II trial specifically studied prostates between 80 and 150cc and demonstrated good outcomes. Your suitability will be confirmed at consultation based on your specific anatomy.

Is Aquablation better than Rezūm?

They address different patient profiles. Rezūm (water vapour/steam therapy) is typically suited to men with smaller prostates and can be done under local anaesthetic, but durability data beyond 5 years is more limited. Aquablation suits a broader size range and carries strong medium-term durability data. Neither is universally "better" — the right choice depends on your anatomy, priorities and general health.

Ask about Aquablation at your consultation

Mr Torath Ameen offers assessment and treatment for benign prostate enlargement at his London clinics. If you would like to discuss whether Aquablation is appropriate for you, book a consultation.

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This article is intended for general patient education only. It does not constitute medical advice and may not apply to every individual's circumstances. Clinical decisions should always be made in consultation with a qualified healthcare professional. If you are concerned about your health, please seek prompt medical assessment.

Aquablation: The Waterjet Prostate Treatment Explained