Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue II

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.