As men get older and their prostates enlarge, that growth can cause problems. And so can traditional treatments.
It is not clear what causes an enlarged prostate, known as benign prostatic hyperplasia (BPH). But the condition is common in older men and affects as many as 33% of men 65 and older according to the National Institute of Diabetes and Digestive and Kidney Diseases. Other sources put that rate even higher.
And it's one more reason for men to make sure they schedule an annual checkup so they can keep their doctor abreast of any issue and be as proactive as possible in pursuing possible treatments.
Men start to notice when the prostate gland swells large enough to disrupt the bladder from emptying. While there is no prevention or cure for BPH, Novant Health Coastal Carolina Hospital patients can now opt for a minimally invasive treatment known as Aquablation therapy. The hospital is located just west of Hilton Head Island and north of Savannah.
“We have been eagerly awaiting this technology,” said urologist Dr. Eric Gwynn, part of the surgical team that in September treated Novant Health’s first Aquablation patient at Coastal Carolina Hospital. “With this new therapy there are huge benefits, including much less risk of incontinence or issues with erections or ejaculation.”
Questions about enlarged prostate? Get answers here.
With the help of AI robotics, surgeons use a water jet to remove excess prostate tissue and reduce the size of the gland. The approach enables precise monitoring of the entire prostate throughout the procedure thanks to live ultrasound imaging.
The biggest advantage: Aquablation treats prostates of any size, making any man a candidate for the surgery. It also poses fewer complications than transurethral resection of the prostate (TURP), which uses electric current and heat to cut out tissue.
There are anesthetic, erectile and ejaculation dysfunction risks with TURP. However, BPH is often treated surgically to avoid further urethral blockage and urinary tract infections.
Gwynn discusses the advantages of Aquablation therapy, which is covered by private insurance and Medicare.
What are the signs of an enlarged prostate?
Usually, beginning in your 50s, your body gives you the signals: Getting up excessively at night to use the bathroom and a stop-and-start urinary stream are common symptoms of BPH.
Before now, how were urologists treating an enlarged prostate?
The gold standard is TURP, which uses cautery—an electric current—to cut the excess tissue and core out the interior of the prostate to improve urinary flow. But that current has potential to damage the nerves responsible for erections, which is why some men could experience erectile dysfunction after the TURP procedure. With Aquablation therapy, there is no electric current; we’re using only water to remove tissue. So there’s no damage to those nerves.
Still, this is like inserting a power-washer into the urethra to blast away prostate tissue. How is the approach minimally invasive?
There is no cutting, so compared to having a surgical incision, Aquablation therapy is minimally invasive. There is not a lot of pain. We put a scope into the urethra to perform water jet ablation, and because we’re not using cautery, patients tend to heal faster. This way there are no erectile issues, and no damage to the urinary sphincter which controls leakage.
How would you compare the two approaches when it comes to accuracy?
Aquablation therapy is much more precise because we perform computer mapping of the resection zone prior to treatment. In addition, we’re using ultrasound to take multidimensional pictures of the prostate in real time. So it’s very precise as compared to TURP, where we resected (surgically removed) the tissue as we went along.
Which men are candidates for this?
In the past, we’ve had prostate size-limits for some of our procedures. With TURP, if the prostate is very large we’re looking for alternative therapies. But every man is a candidate for Aquablation therapy, because it can treat any-sized prostate.
Aquablation can take less than one hour versus one to two hours for TURP, and recovery is brief. General anesthesia is used, as well as a catheter during a required overnight stay at the hospital. Within a few days most patients are back to their lives without a catheter, though they can expect mild burning for a couple of weeks.
Aquablation treatment restored comfort and energy for Ronald Bell
By Bonnie Davis
Ronald Bell starts every morning with the same kind of excitement most people outgrow by kindergarten.
“I wake up like a 5-year-old with the toys in the sandbox,” he says.
At 67, Bell owns a small hobby farm in the far western part of Yadkin County, where retirement is looming on the horizon and filled with plans to spend more time “playing” — tending his garden, canning his own vegetables and working his apple and peach trees. His sawmill, bulldozer and hay baler keep him busy and happy. A land surveyor by trade, Bell prefers life close to the land.
But for years, one health issue quietly took over his life.
Bell was living with a benign prostatic hyperplasia (BPH), commonly known as enlarged prostate, that made it nearly impossible to fully empty his bladder. This condition affects approximately 50% of men aged 51 to 60 and 80% of those aged 70 or older, leading to symptoms such as frequent urination and urgency.
Bell had all these symptoms and was waking up every hour throughout the night to use the bathroom. When he did go, it was never enough relief to feel comfortable.
“It was exhausting and frustrating,” Bell said. “You don’t realize how much it controls your life until you can’t get a good night’s sleep.”
His primary care doctor referred him to Dr. Paul McClain and Dr. Oliver Benton, urologists who practice at Novant Health Urology – Kimel Park in Winston-Salem. They recommended a newer treatment option called Aquablation — a minimally invasive, robot-assisted procedure that uses a precise water jet to target and remove excess prostate tissue while preserving important functions.
Both doctors performed the procedure in September 2025, and for Bell, the results were life-changing.
“For a patient like Ron, who leads a very active life, it’s been very gratifying to offer a treatment that could make such a difference in his quality of life,” McClain said. “Aquablation offers relief without the tradeoffs many men worry about, and he experienced exactly the kind of outcome we hope for — a quick recovery and meaningful relief.”
Almost immediately, Bell noticed a dramatic improvement in his sleep. His smartwatch confirmed what his body already felt — that his sleep score had jumped significantly. Nights were no longer interrupted by constant bathroom trips, and days were no longer fueled by fatigue.
Bell admits the experience itself requires a sense of humility because “they’re working on your privates,” he laughed, adding that the pain was manageable and the recovery was quick. Just as importantly, his sexual function returned and continues to do well.
He is also quick to point out how important it is to follow the doctors’ orders to not do anything strenuous for at least six weeks following the procedure. “You have made a mistake if you do what Ron Bell did,” he said, admitting he overdid it just a bit.
Now back to full strength, Bell has returned to his regular routines on the farm and at work. He’s also looking forward to getting back on his bike. As an avid cyclist, he’s missed the exercise and traveling the back roads near home.
“The procedure worked great. It gave me my life back,” he said. “I would recommend it to anyone who needs it and urge them not to wait to get help.”
