Aquablation is a waterjet ablation therapy for benign prostatic hyperplasia (BPH) that has gained increasing attention. While its efficacy, durability, and safety have been demonstrated across various prostate sizes (30–150 mL), local data in Taiwan remain limited. This study presents our initial experience with 50 patients who underwent Aquablation.

We retrospectively reviewed 50 consecutive patients who underwent Aquablation between March 2024 and February 2025, divided into Group I (first 25 cases) and Group II (subsequent 25 cases). Parameters assessed included IPSS, QoL, uroflowmetry (voiding volume, Qmax, Qmean, PVR), operative time, hemoglobin drop, Clavien-Dindo grade ≥2 complications, hospital stay, and catheter duration.

Group II patients were younger and had smaller prostates. Aquablation was successful in all cases. IPSS, QoL, Qmax, Qmean, and voiding volume improved significantly and were sustained at 3 months. PVR improved significantly only in Group I. Operative time was shorter in Group II, while hemoglobin drop was greater in Group I. Complications, hospital stay, and catheter duration were comparable.

Aquablation led to significant symptom and uroflow improvements, with better PVR outcomes in larger prostates. Surgical efficiency improved after 25 cases. Aquablation appears safe and effective, even in an unselected patient population.