A systematic review and meta-analysis on the safety and efficacy of Aquablation

Objectives This work aimed to evaluate the efficacy and safety of Aquablation for the treatment of benign prostatic enlargement. Methods A systematic review was conducted in accordance with PRISMA 2020 guidelines (PROSPERO CRD420261401865). A comprehensive PubMed search identified prospective studies and randomised controlled trials published up to January 2026. Studies including ≥30 patients reporting clinical outcomes of Aquablation were included. Guidelines, case reports, review articles, letters, retrospective studies with pooled data were excluded. Primary outcomes were International Prostate Symptom Score, maximum flow rate, postvoid residual and sexual function. Secondary outcomes included perioperative parameters and complications. Random-effects meta-analysis using DerSimonian–Laird was performed for outcomes reported in three or more studies. Results Fifteen studies comprising 1580 patients were included. Mean age and prostate volume were 67.0 years and 82.1 cc, respectively. Aquablation significantly improved urinary outcomes, with a pooled IPSS reduction of −15.80 at 6 months (95% confidence interval [CI] −17.88 to −13.73; I2 = 97.8%), sustained to 36 months. Qmax increased by 11.0 mL/s (95% CI 8.93–13.02; I2 = 95.1%), while PVR decreased by 103.8 mL (95% CI −139.5 to −68.0; I2 = 98.1%) at 6 months. Ejaculatory dysfunction occurred in 7.4% of patients, with no reported erectile dysfunction. The transfusion rate was 2.5%, with lower rates observed using focal bladder neck cautery. Most complications were low grade. Conclusion Aquablation provides durable and significant improvements in urinary outcomes with a favourable safety profile and low rates of sexual dysfunction, supporting its role as an effective surgical option for BPE.