This study evaluates the 4-year safety and efficacy of Aquablation, a robotic-assisted water jet technology for treating men with symptomatic BPH. The study included 265 men with a mean prostate volume of 106.3 mL. Results showed significant symptom improvement, with a decrease in IPSS from 24.2 to 5.1, and an increase in urinary flow rate from 6.4 to 16.9 mL/sec. Postoperative complications were low, with 99% of men preserving antegrade ejaculation. Aquablation proved to be a safe, effective treatment for BPH with long-term benefits.