Single-arm, interventional pivotal clinical trial collecting patient data from use of the AQUABEAM System, a personalized image-guided waterjet resection system that utilizes a high-velocity saline stream to resect and remove prostate tissue in males suffering from Lower Urinary Tract Symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) with prostate volumes between 80 mL and 150 mL. The primary endpoints for safety and effectiveness will be measured at 3 months post-treatment. Treated subjects will be followed out to 60 months to collect long-term clinical data.

Inclusion Criteria:

• Male age 45-80 years.
• Subject has diagnosis of lower urinary tract symptoms due to benign prostatic enlargement causing bladder outlet obstruction.
• Subject has an IPSS score greater than or equal to 12.
• Maximum urinary flow rate (Qmax) less than 15mL/s.
• Serum creatinine < 2 mg/dL within 30 days of surgery.
• History of inadequate or failed response, contraindication, or refusal to medical therapy.
• Prostate size ≥ 80 mL and ≤ 150 mL as measured by TRUS.
• Patient is mentally capable and willing to sign a study-specific informed consent form.

Exclusion Criteria:

• BMI ≥ 42.
• Patients unable to stop anticoagulants, antiplatelet agents, or non-steroidal anti-inflammatory agents (NSAIDs, including aspirin greater or equal to 100mg) prior to treatment per standard of care.
• Participants using systemic immune-suppressants including corticosteroids (except inhalants); unable to withhold non-steroidal anti-inflammatory agents (NSAIDs, including aspirin) prior to treatment per standard or care except for low dose aspirin (e.g. less than or equal to 100mg).
• Contraindication to both general and spinal anesthesia.
• Any severe illness that would prevent complete study participation or confound study results.
• History of prostate cancer or current/suspected bladder cancer. Prostate cancer should be ruled out before participation to the satisfaction of the investigator if PSA is above acceptable thresholds.
• History of actively treated bladder cancer within the past two (2) years.
• Clinically significant bladder calculus or bladder diverticulum (e.g., pouch size >20% of full bladder size).
• Active infection, including urinary tract infection or prostatitis.
• Urinary catheter use daily for 90 or more days consecutively.
• Previous urinary tract surgery such as e.g. urinary diversion, artificial urinary sphincter or penile prosthesis.
• Ever been diagnosed with a clinically significant urethral stricture or meatal stenosis, or bladder neck contracture.
• Known damage to external urinary sphincter.
• Has had an open heart surgery, or cardiac arrest < 180 days prior to the date of informed consent.
• Participants using anticholinergics specifically for bladder problems. Use of medications with anticholinergic properties is allowable provided the patient does not have documented adverse urinary side effects from these medications.
• Subject is unwilling to accept a transfusion should one be required.