Same relief as TURP,
without the same trade
TURP has been the benchmark prostate surgery for seventy years, and it earned it. Aquablation was tested against it head-to-head in a randomized trial and matched its relief, while preserving ejaculation several times more often. Dr. Sawkar has performed more than 250 Aquablation procedures, the most of any surgeon in Orange County; here is the comparison he walks patients through.
Medically reviewed by Hari Sawkar, MD, board-certified urologist · Updated August 2026
Side by side
Both remove obstructing tissue through the urethra. The difference is how: TURP carves with a heated electric loop, guided by eye; Aquablation resects with a heat-free waterjet executing a robotic plan built on live ultrasound.
| Aquablation | TURP | |
|---|---|---|
| Method | Heat-free robotic waterjet, ultrasound-mapped | Heated wire loop, surgeon-steered by eye |
| Symptom relief | Equivalent to TURP in the randomized WATER trial | The 70-year benchmark |
| Ejaculation preserved | Most men | Lost in roughly two-thirds of men |
| Large glands (80-150 cc) | Consistent, proven in WATER II | Slower, less complete, often avoided |
| Heat injury risk | None from resection, waterjet is heat-free | Present, including rare stricture and TUR syndrome |
| Hospital and catheter | One night, catheter 1-2 days | One night, catheter 1-2 days |
| Consistency | Robot executes the same plan every time | Depends heavily on the individual surgeon |
Sources include the randomized WATER and WATER II trials. Your anatomy and history may shift the picture, which is what the consultation resolves.
The bottom line
If you have been told you need TURP, you owe yourself one conversation before scheduling it. For most surgical candidates the modern trade favors Aquablation: the same relief, dramatically better odds of preserving ejaculation, and results that do not depend on how steady one surgeon's hand is on one afternoon. And if the real goal is avoiding the operating room entirely, PAE treats the same problem without surgery at all, which is a different comparison worth reading.
Common questions
Is Aquablation better than TURP
In the randomized WATER trial, symptom relief was equivalent, while ejaculatory dysfunction was several-fold lower after Aquablation. For large prostates, Aquablation outperformed where TURP struggles. TURP remains a proven benchmark, but for most candidates the modern trade favors the robot.
Why do surgeons still do TURP
It has a seventy-year track record, works well in experienced hands, and is available everywhere, while Aquablation requires a robotic system and specific surgeon training. Where both are available, the choice usually comes down to the sexual-function difference and gland size.
Is the recovery different
Broadly similar: both involve a hospital stay, a catheter for a day or two, and one to two weeks back to routine. The meaningful differences are during and after: less bleeding risk with the heat-free waterjet in trials, and far better preservation of ejaculation.
Does insurance cover Aquablation like TURP
Yes. Aquablation is typically covered by Medicare and most PPO and commercial plans the same way TURP is, when BPH symptoms are documented. The office verifies your specific coverage before anything is scheduled.
Told you need TURP? Talk first.
A second opinion with a measured prostate costs one visit and can change the next decade. Same-day and next-day appointments, telehealth available, Medicare and most PPO plans accepted.
Chief of Urology, Providence St. Joseph Hospital · 250+ Aquablation procedures, the most in Orange County