Ravi Munver, MD, highlights study of first- and second-generation Aquablation systems

In this interview, conducted at the 2026 American Urological Association Annual Meeting, Ravi Munver, MD, discusses findings from a propensity score–matched comparison of the first-generation AquaBeam system and the second-generation HYDROS platform for Aquablation in patients with benign prostatic hyperplasia (BPH).¹ Munver is the vice chair and professor of urology at Hackensack University Medical Center in Hackensack, New Jersey.

Munver explained that HYDROS was developed as a second-generation robotic waterjet therapy platform designed to build on the original AquaBeam system by improving visualization, increasing surgeon confidence, and helping standardize the procedure. Introduced in September 2024, the AI-powered platform identifies key anatomic landmarks and suggests an optimal treatment plan, allowing improved consistency and efficiency.

The investigators evaluated perioperative outcomes in patients who underwent Aquablation with either the first-generation AquaBeam system or the HYDROS platform using propensity score matching to account for baseline characteristics, including age, body mass index, prostate volume, and median lobe size. After matching, 46 patients were included in each cohort.

Overall, perioperative outcomes were encouraging with both systems, with no significant differences in operative time (P = .662), estimated blood loss (P = .592), intraoperative complications (P = .324), or readmissions (P = .164). No patients in either cohort required blood transfusion, and no patients experienced ejaculatory dysfunction. At 6 months, the median International Prostate Symptom Score were 8 with AquaBeam and 5 with HYDROS (P = .12). The median Qmax was 18.3 ml/s in the AquaBeam arm and 18.1 ml/s in the HYDROS arm (P = 1.0).

The only significant difference observed was a longer median duration of the second waterjet pass with HYDROS (3.35 vs 3.02 minutes; P = .004). According to Munver, this finding likely reflects increased surgeon confidence afforded by enhanced ultrasound imaging, integrated digital cystoscopy, and AI-guided treatment planning, enabling more comprehensive tissue resection.

REFERENCE

1. O’Hara J, Paek B, Gmelich C, et al. IP21-25: A PROPENSITY MATCHED ANALYSIS OF TRANSURETHRAL ROBOTIC WATERJET THERAPY SYSTEMS: 1ST GENERATION PLATFORM (AQUABEAM) VERSUS 2ND GENERATION AI-POWERED PLATFORM (HYDROS). J Urol. 2026;215(5S):e444. doi:10.1097/01.JU.0001191392.98192.68.25