Robotic waterjet precision,
heat-free
Aquablation removes the obstructing prostate tissue with a robotically controlled, heat-free saline waterjet, guided by real-time ultrasound. A precise, consistent option that works across the full range of prostate sizes. Dr. Sawkar has performed more than 250 Aquablation procedures at Providence St. Joseph Hospital, the highest volume of any surgeon in Orange County.
Medically reviewed by Hari Sawkar, MD, board-certified urologist · Updated August 2026
How Aquablation works
Aquablation pairs real-time ultrasound imaging with a computer-controlled robotic arm to map and remove the obstructing prostate tissue using a high-velocity saline waterjet. Because the waterjet uses no heat, the risk of thermal injury to the surrounding nerves and sphincters is minimized.
The robotic system carries out the plan with sub-millimeter accuracy every time, regardless of prostate size or complexity, which makes it especially well suited to large or complex prostates. Dr. Sawkar has performed more than 250 Aquablation procedures, the highest volume of any surgeon in Orange County and among the highest on the West Coast.
Anesthesia
The procedure is done in the hospital under spinal or general anesthesia, typically with one night's stay.
Ultrasound mapping
A transrectal ultrasound builds a 3D map of the prostate, defining exactly which tissue to remove.
Waterjet resection
A heat-free saline waterjet removes the planned tissue with robotic, sub-millimeter precision.
Recovery
A catheter stays in for a day or two. Most men return to normal activities within one to two weeks.
Why men choose Aquablation
Works for any prostate size
Proven for small, medium, and large prostates, including complex anatomies that challenge other approaches.
Heat-free technology
No thermal energy means no heat-related damage to the nerves, sphincters, and structures around the prostate.
Robotic precision
Computer-controlled delivery removes exactly the planned tissue, for consistent results case after case.
250+ procedures and counting
The highest Aquablation volume of any surgeon in Orange County, and among the highest on the West Coast.
Is Aquablation right for you
Aquablation is the surgical-grade option of the four: real tissue removal, one time, with the robot protecting what matters. It fits a specific patient, and imaging confirms the fit first.
Almost any size or shape
Proven from 30 to 150 cc, including large glands and median lobes that rule out the office procedures entirely.
You want one-and-done durability
Tissue is physically removed, so the result is the most definitive of the minimally invasive options, with retreatment uncommon.
Function still matters to you
The heat-free waterjet and robotic planning were designed to spare the structures responsible for continence and ejaculation.
A night in the hospital is acceptable
Spinal or general anesthesia, typically one overnight stay, and a catheter for a day or two. Men who want to avoid the OR entirely usually look at PAE.
Because Dr. Sawkar offers Aquablation alongside PAE, UroLift, and Rezūm, the recommendation follows your measured anatomy and your goals, not the nearest machine. Whichever page brought you here, the consultation starts from the full menu.
What the evidence shows
Aquablation was tested the hard way: head-to-head against TURP, the century-old surgical benchmark, in the randomized WATER trial, with a companion WATER II study dedicated to large 80 to 150 cc glands.
TURP-grade relief
Symptom relief matched the surgical gold standard, and in larger prostates Aquablation outperformed, precisely where traditional surgery gets hardest.
Function protected
Rates of ejaculatory dysfunction were several-fold lower than TURP's, the result of heat-free resection and robotic planning that spares key structures.
Experience compounds
Outcomes track with surgical planning, and planning improves with volume. With more than 250 cases, Dr. Sawkar holds the highest Aquablation volume in Orange County, among the highest on the West Coast.
Recovery, in plain terms
Expect one night in the hospital and a catheter for a day or two. Some blood in the urine during the first days is normal and clears. Desk work resumes within about a week for most men, with heavy lifting and hard exercise on hold for two to four weeks while the prostate heals from the inside. Flow improvement is typically obvious as soon as the catheter comes out, and it is durable, because the obstructing tissue is gone rather than pushed aside or shrunk.
Common questions about Aquablation
Is Aquablation real surgery
Yes. It is a hospital procedure under spinal or general anesthesia in which obstructing tissue is physically removed. What sets it apart from traditional surgery is how: a heat-free waterjet executing a robotic plan built from live ultrasound, designed to protect continence and sexual function.
How is Aquablation different from TURP
In the randomized WATER trial, symptom relief matched TURP while ejaculatory dysfunction was several-fold lower. The robot also makes results consistent across prostate sizes and shapes, including large glands where TURP becomes slow and less complete.
Is my prostate too large for Aquablation
Rarely. It is proven from 30 to 150 cc, a wider range than almost any other option. Beyond roughly 150 cc, PAE, which has no practical size ceiling, usually enters the conversation, and Dr. Sawkar offers both.
Will it affect ejaculation or erections
Far less than traditional surgery. Heat-free resection and robotic planning spare the structures involved, and most men preserve ejaculation, a several-fold improvement over TURP in trial data. Erections are typically unaffected.
Does the surgeon's volume matter
Yes. The robot executes the plan, but the surgeon builds it, and planning judgment comes from repetition. Dr. Sawkar has performed more than 250 Aquablation procedures at Providence St. Joseph Hospital, the highest volume in Orange County and among the highest on the West Coast.
Who performs Aquablation in Orange County
Dr. Hari Sawkar, board-certified urologist and Chief of Urology at Providence St. Joseph Hospital, performs Aquablation there, with more than 250 procedures, the highest volume in Orange County. Consultations run through his Santa Ana office, with same-day and next-day appointments available.
See if Aquablation is right for you
Same-day and next-day appointments. Aquablation is typically covered by Medicare and most commercial plans, with telehealth consultations available. For the fastest response, send the office a secure message; the reply comes back by text.
Chief of Urology, Providence St. Joseph Hospital · UroLift Center of Excellence · Orange County's highest-volume Aquablation surgeon