How to cite: Helfand BT. “Aquablation: How I Do It.” Grand Rounds in Urology. October, 2025. Accessed Apr 2026. https://grandroundsinurology.com/aquablation-how-i-do-it/
Summary
Brian T. Helfand, MD, PhD, Chief of Division of Urology, Associate Chief Scientific Officer, Clinical Professor, NorthShore University Health System, University of Chicago, Evanston, Illinois, presents his approach to aquablation, focusing on practical steps to help surgeons perform the procedure safely and consistently.
Dr. Helfand evaluates all patients with a standard benign prostatic hyperplasia (BPH) workup, including symptom scoring, urinalysis, post-void residual assessment, cystoscopy, and ultrasound or magnetic resonance imaging (MRI) when appropriate. He highlights that patient counseling is essential.
Dr. Helfand describes how he prepares by confirming the prostate dimensions and planning the resection contour in the aquablation software. He begins with a midline pass, followed by tailored lateral lobe treatment, and then moves to apical tissue while protecting the sphincter. He uses real-time ultrasound guidance to verify tissue depth and ablation boundaries.
He describes key efficiency steps, including coordinating with anesthesia, establishing a straightforward workflow for catheter placement, and ensuring the nursing team is familiar with the handoff and postoperative monitoring. He also reviews strategies to reduce bleeding through controlled resection depth and selective use of cautery. Dr. Helfand notes that most patients can be discharged the same day or the next morning, and that catheter removal is often possible within 24 to 48 hours.
He concludes that aquablation is a reproducible procedure that offers consistent symptom relief and can be adopted safely with proper planning, team coordination, and adherence to a structured technique.
Frontiers in Oncologic Prostate Care and Ablative Local Therapy (FOCAL) is an outstanding program on prostate imaging, transperineal interventions, and ablative treatments for prostate cancer and benign prostatic hyperplasia. Bringing together community-based, academic, and industry partners, FOCAL offers lectures by world-renowned faculty and hands-on training workshops on in-office transperineal interventions, fusion-guided prostate ablation and state-of-the-art BPH management with novel technologies.
ABOUT THE AUTHOR
Brian T. Helfand, MD, PhD, is Chief of the Division of Urology and an Associate Chief Scientific Officer at NorthShore University HealthSystem in Evanston, Illinois. Dr. Helfand also serves as a Clinical Professor at the University of Chicago. He specializes in urologic oncology and the treatment of prostate conditions. Dr. Helfand’s clinical expertise includes minimally invasive surgery, advanced laparoscopy, and procedures using the da Vinci robotic system.
