Aquablation Therapy vs. Laser Enucleation: WATER III Trial Results Reveal Game-Changing Outcomes

The biotech world is abuzz with the latest findings from the WATER III trial, which compared Aquablation therapy to laser enucleation for treating large prostates. Presented at the prestigious European Association of Urology (EAU) 2025 Annual Congress in Madrid, Spain, the results are nothing short of groundbreaking. The trial, an international, prospective, multicenter study, treated 186 men with prostate sizes ranging from 80 to 180 mL between December 2020 and September 2024. The three-month results, which were the primary safety and efficacy endpoints, have set the stage for a potential paradigm shift in the treatment of benign prostatic hyperplasia (BPH).



The WATER III trial demonstrated that Aquablation therapy delivered substantially similar symptom relief compared to laser enucleation. However, the real game-changer lies in the significantly lower rates of ejaculatory dysfunction (14.8% vs. 77.1%) and stress incontinence (0% vs. 9.1%) reported in the Aquablation therapy arm. Additionally, the procedural transfusion rate in the Aquablation therapy arm was 0%, underscoring the safety and reproducibility of the procedure in managing bleeding risk.

Reza Zadno, CEO of PROCEPT BioRobotics, the company behind Aquablation therapy, hailed the results as a significant milestone. "WATER III represents a significant milestone in our mission to establish Aquablation therapy as the standard of care for patients suffering with BPH," he said. "Building on our previous randomized WATER data comparing Aquablation therapy to TURP, WATER III demonstrates that Aquablation therapy delivers compelling clinical outcomes compared to laser enucleation. What makes these results particularly meaningful is Aquablation therapy's ability to deliver effective symptom relief while preserving critical quality of life factors—specifically sexual function and continence. These findings reinforce our dedication to providing treatments that address the complete patient experience."

Dr. Naeem Bhojani, a urologist at the University of Montreal, echoed these sentiments. "The WATER III results are impressive, demonstrating that Aquablation therapy can achieve outcomes comparable to laser enucleation," he said. "The consistent efficacy coupled with the significantly lower rates of ejaculatory dysfunction and stress incontinence represents a meaningful advancement for patients seeking treatment for BPH. The effectiveness of Aquablation therapy is shown by its ability to achieve similar results as highly skilled and experienced laser enucleation surgeons."

The WATER III trial adds to the growing body of clinical evidence supporting Aquablation therapy. The randomized WATER study (Aquablation therapy vs. TURP in 30-80 mL prostates) with five-year results, WATER II (Aquablation therapy in large prostates 80-150 mL) with five-year results, and over 150 peer-reviewed publications all point to Aquablation therapy as a globally reproducible procedure with the potential to become the BPH standard of care for all prostate sizes.



The WATER III trial results are a testament to the transformative potential of Aquablation therapy. The procedure's ability to deliver effective symptom relief while preserving sexual function and continence makes it a compelling option for patients suffering from BPH. As the clinical evidence continues to mount, it is clear that Aquablation therapy is poised to become the new standard of care for BPH treatment. The future of urology looks bright, and Aquablation therapy is leading the charge.