Robotic waterjet ablation enhances urology care at Cheltenham General Hospital
Gloucestershire Hospitals first introduced Aquablation therapy in 2023, a pioneering robotically-assisted surgical technique, to treat men with benign prostatic hyperplasia (BPH)
The AquaBeam Robotic System from PROCEPT BioRobotics uses a heat-free high-pressure waterjet to remove prostate tissue precisely. This provides long-lasting relief from symptoms while preserving sexual function and urinary continence.
BPH is a non-cancerous enlargement of the prostate gland; this affects many men over 50 and can cause frequent urination, needing to get up at night to pass urine (nocturia) and reduced urinary flow. Left untreated, BPH can lead to bladder problems that may require a catheter (a tube used to drain urine). Traditional surgery, such as transurethral resection of the prostate (TURP), can be effective but may involve longer recovery times, variable procedure lengths and a higher risk of complications.
The AquaBeam system uses robotic assistance with real-time imaging and planning software to remove prostate tissue while preserving areas important for sexual function. The procedure is carried out in small, controlled steps called passes with each pass taking around three to four minutes regardless of prostate size. This predictable timing allows multiple patients to be treated efficiently and effectively in a single day, which helps reduce long waiting lists and allows patients to be treated sooner.
UK first: 7 patients treated in a single session
In a recent operating list, 7 patients were treated as day cases in a single day, marking a UK first for the number of procedures completed in one session. A senior urology trainee performed the procedures, demonstrating that the system is safe and effective for surgical training.
Consultant Surgeon and Urology Clinical Lead Jeremy Nettleton said, “The AquaBeam system has transformed how we treat BPH. It provides lasting symptom relief, preserves sexual function and continence and helps patients get back to their normal lives quickly. .”
Senior Surgical Registrar Jake Wilson, who performed the seven procedures in one day, said, “This is a great example of how the Trust can get through a high volume of innovative robotic procedures as day cases whilst providing excellent training at the same time. It’s a win-win for all involved. I’m very grateful to Jeremy, the team at PROCEPT and the Trust.”
This milestone was achieved in a single theatre under routine conditions, with close supervision from Mr Nettleton. The technology’s predictable performance and low-pressure operating environment make it ideal for teaching, allowing trainees to follow a standardised process safely while reducing variability.
It is exciting to see this technology benefit both patients and our surgical trainees
Jeremy Nettleton, Consultant Surgeon and Urology Clinical Lead
A difference for patients
Patients have noticed the difference. One said, “The procedure was straightforward and I was home the same day. My symptoms have improved and I can enjoy everyday activities again without disruption.”
Patients are usually referred into the Urology service by their GP after initial treatment via medication management. If symptoms persist, the AquaBeam system offers a durable solution with fewer side effects, faster recovery and improved outcomes for men across Gloucestershire.
Cheltenham General Hospital is the Trust’s centre of excellence for Urology services.
Gloucestershire Hospitals is one of a small number of NHS trusts using this technology, which has been more widely adopted in private healthcare. Its use reflects a commitment to innovation, patient-centred care and developing the next generation of surgical talent.