Insights from One of the Nation’s Busiest Aquablation Practices

Since January 2025, NYU Langone Health urologist Christopher E. Kelly, MD, has transitioned his Aquablation practice to a fully outpatient model, allowing patients to benefit from the durable, minimally invasive treatment for benign prostatic hyperplasia (BPH) while avoiding an overnight hospital stay.

This shift, he explains, reflects years spent refining intraoperative bleeding control, postoperative management, and tightly coordinated perioperative workflows.

“Over the course of more than 1,000 Aquablation procedures, I’ve dramatically reduced the need for hospital stays by refining my technique and developing rigorous protocols in collaboration with nursing and anesthesiology teams,” Dr. Kelly says.

As an early adopter, Dr. Kelly has performed the most Aquablation procedures in the US to date and the second most worldwide, giving him a uniquely high-volume perspective on technique optimization, patient selection, and expanding indications.

NYU Langone performed the first Aquablation procedure in the New York–New England region in 2019 and now has two Aquablation delivery systems in use in Manhattan. In addition to Dr. Kelly, NYU Langone colleagues Joel Hillelsohn, MD, Benjamin M. Brucker, MD, and Philip T. Zhao, MD, offer this cutting-edge technology in Manhattan, while Jeffrey T. Schiff, MD, MPH, Wilson Lin, MD, and Eric Moskowitz, MD, provide the procedure on Long Island.

A Fine-Tuned Approach

While standard Aquablation protocols emphasize focal neck cauterization for bleeding control, Dr. Kelly describes his method as a more comprehensive survey of every potential bleeding site, combined with meticulous intraoperative and postoperative blood pressure control and precise catheter placement and traction.

In his practice, layering these refinements onto standard Aquablation hemostasis protocols has significantly reduced postoperative bleeding and nearly eliminated hospital stays.

Transrectal ultrasound guidance in Aquablation adds another layer of procedural control, Dr. Kelly says, enabling extensive preoperative planning—determining not only where to remove or preserve tissue, but also how to anticipate and minimize bleeding risk before surgery even begins. “Hemostasis begins with meticulous planning of the water jet,” Dr. Kelly emphasizes.

Decision-Making Axes

What distinguishes Aquablation from other BPH procedures is the ability to preserve ejaculatory function while delivering durable relief of obstruction, with lower rates of incontinence and erectile dysfunction. In counseling patients, Dr. Kelly emphasizes two primary decision-making axes: durability and patient values around sexual function, particularly anterograde ejaculation.

“Aquablation is the standout procedure for small, medium, to large prostate glands when preservation of ejaculation is a priority,” Dr. Kelly says.

While Aquablation is commonly used for medium to larger prostates, smaller glands requiring limited tissue removal are still commonly managed with established procedures. However, in select patients with smaller but anatomically constricted “tight” glands, where thermal techniques may jeopardize the ejaculatory ducts, Dr. Kelly has increasingly favored Aquablation over heat-based options such as transurethral resection of the prostate (TURP) or GreenLight laser therapy, citing improved preservation of ejaculatory function with excellent de-obstruction.

For very large glands, he considers Aquablation but also considers holmium laser enucleation of the prostate (HoLEP) and robotic simple prostatectomy, acknowledging that these alternative procedures are highly effective and durable, but less favorable for preserving ejaculation. In some cases, Dr. Kelly considers prostate arterial embolization (PAE), an interventional radiology procedure that restricts the prostate’s blood supply to preoperatively downsize glands.

Expanding Applications

Aquablation continues to see broader adoption in BPH management, driven in large part by a growing commitment to aligning surgical decisions with patients’ sexual health priorities. “Men are opening up about their sexual health needs, and we as surgeons are making space for those conversations,” Dr. Kelly says. “This technology allows me to offer more holistic, compassionate care.”

Looking ahead, the role of Aquablation is expected to continue expanding. Dr. Kelly and colleagues at NYU Langone are participating in ongoing clinical trials exploring its use in localized prostate cancer, while AI-assisted guidance and advances in ultrasound are making the procedure more accessible to new adopters.

“We’re using transrectal ultrasound guidance, which is a safer way to approach the gland. We’re using less heat, which is a major win. And we’re removing a significant amount of tissue for robust results while preserving sexual function,” Dr. Kelly says. “We’ve just entered a new era.”