In this article, the authors provide an overview of aquablation, the world’s first image-guided, automated, robotically controlled waterjet ablative therapy developed for treating benign prostatic hyperplasia. Unlike traditional ablative methods, it uses a high-velocity, heat-free saline jet to ablate prostate tissue with minimal damage to surrounding structures. Preserving sexual function, including ejaculatory integrity, is a significant advantage of aquablation. Real-time ultrasound guidance and automated robotics facilitate treatment customization based on the individual, resulting in reproducible outcomes regardless of prostate shape and size. Long-term studies confirm aquablation’s durability with sustained symptom relief, improved urinary function, and reduced retreatment rates.