Abstract
Robotic waterjet ablation (RWJA), known by the trade name of Aquablation, is a minimally invasive, heat-free technique for treating benign prostatic hyperplasia (BPH) that offers comparable efficacy to transurethral resection of the prostate (TURP). Unlike TURP, RWJA utilizes targeted tissue mapping, potentially enhancing the preservation of sexual function, particularly antegrade ejaculation. This systematic review evaluated sexual outcomes following RWJA, emphasizing ejaculatory dysfunction and antegrade ejaculation preservation. A literature search conducted through January 1, 2025, in PubMed, Embase, and Cochrane databases identified 15 studies involving 1533 patients. Preservation rates of antegrade ejaculation post-RWJA ranged from 72 to 99.6%. Erectile function remained stable across all reviewed studies. Notably, a randomized controlled trial comparing RWJA to TURP demonstrated significantly lower rates of ejaculatory dysfunction in the RWJA group, maintained for up to five years. Despite promising findings indicating durable preservation of ejaculatory function, there remain limitations due to a scarcity of randomized controlled trials and limited long-term follow-up beyond 12 months. Future comparative studies evaluating RWJA against other minimally invasive BPH treatments are needed to further validate these findings and better define the sexual function outcomes associated with this innovative procedure.