PROCEPT BioRobotics Q2 Earnings Call Highlights
Key Points
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- Second-quarter revenue rose 19% year over year to $94.5 million, but weaker utilization at legacy AquaBeam accounts led PROCEPT to lower its 2026 U.S. procedure outlook to 54,000–56,000. The company maintained full-year revenue guidance of $390 million–$410 million, supported by pricing and replacement-system sales.
- HYDROS systems continued to outperform legacy accounts, prompting an accelerated upgrade strategy. PROCEPT placed 65 HYDROS systems in the quarter and expanded its launch team, which now supports about 40% of new placements to improve time to first procedure and early utilization.
- Higher spending on commercial initiatives, platform innovation and clinical trials increased the full-year operating-expense outlook to $355 million–$360 million. Management still expects positive adjusted EBITDA in the fourth quarter, while WATER IV trial results are expected in spring 2027.
PROCEPT BioRobotics (NASDAQ:PRCT) reported second-quarter revenue growth of 19% year over year while lowering its full-year U.S. procedure outlook, citing softer activity at legacy AquaBeam accounts. Management said newer HYDROS Robotic System accounts continued to show stronger utilization, supporting an accelerated replacement strategy for older systems.
Total revenue for the second quarter of 2026 was $94.5 million, including U.S. revenue of $83.4 million, up 20% from a year earlier. International revenue rose 15% to $11.1 million. The company completed more than 13,100 U.S. procedures during the quarter, an increase of approximately 21%, though Chief Executive Officer Larry Wood said the result was below expectations.
Legacy AquaBeam Accounts Weigh on Procedures
Wood said the procedure shortfall was concentrated primarily among legacy AquaBeam accounts rather than across the company’s installed base. HYDROS accounts, by contrast, had procedures per account “significantly exceeding” those of legacy AquaBeam locations during the quarter, according to management.
“HYDROS continues to perform well,” Wood said, adding that the platform’s imaging, workflow and clinical capabilities were helping physicians adopt Aquablation more quickly and use the system more consistently.
The company now expects 2026 U.S. procedures of 54,000 to 56,000, representing growth of approximately 25% to 29% from 2025. Wood said the low end of that outlook assumes no improvement in legacy AquaBeam account performance and little improvement in HYDROS utilization, while the high end incorporates benefits from commercial initiatives and system upgrades.
Management said it does not fully understand the recent decline in legacy AquaBeam utilization. Wood noted that physicians practicing at multiple hospitals may preferentially shift patients to HYDROS-equipped locations because of the newer system’s efficiency, imaging and artificial-intelligence capabilities.
Replacement Cycle and Launch Team Expand
PROCEPT placed 65 HYDROS systems in the U.S. during the quarter, including 50 greenfield placements, 14 replacement systems and one system under an operating lease. U.S. system revenue increased 32% year over year to $29.1 million.
The company is accelerating upgrades of legacy AquaBeam systems to HYDROS. It expects approximately 40 replacement sales at the midpoint of its full-year revenue outlook, with replacement-system average selling prices expected to range from approximately $300,000 to $325,000. Wood said replacement activity should remain an important part of the commercial strategy in 2027 as well.
While upgrades can create modest near-term disruption as facilities transition between platforms, management expects the program to improve account productivity over time. Wood said HYDROS represented about half of the installed base, but accounted for the majority of procedure volume for the first time in the second quarter.
The company also continued to expand its dedicated launch team, which is intended to speed the time from installation to first procedure and improve early utilization. Approximately 40% of HYDROS systems placed in the second quarter were launched through the specialized team, up from about 20% in the first quarter. Management expects another meaningful increase in the third quarter and said it expects to have the capacity to support launches for all new HYDROS systems by year-end.
Wood said launch-team accounts have shown shorter times to first cases, more surgeons trained on the system and higher initial case volumes, though the company did not quantify the utilization difference.
Pricing Strength Supports Maintained Revenue Outlook
Despite the reduced procedure outlook, PROCEPT maintained its full-year revenue guidance of $390 million to $410 million, which would represent growth of approximately 27% to 33% from 2025. The company also maintained its international revenue forecast of $50 million to $51 million.
Management pointed to strong system pricing and replacement sales as support for the revenue outlook. New U.S. HYDROS system average selling price was approximately $495,000 in the second quarter, compared with $485,000 in the first quarter and $435,000 for full-year 2025. The company expects new U.S. system average selling prices of approximately $480,000 to $490,000 in the second half.
U.S. handpiece and other consumable revenue was $48.4 million, up 12% year over year. Handpiece sales represented roughly 98% of procedures in the quarter, while handpiece average selling price increased to approximately $3,550. CFO Kevin Waters said the company still expects an approximately one-to-one relationship between handpieces sold and procedures for the full year.
Management said its full-year system outlook implies 210 to 220 greenfield system placements, excluding replacement systems. Waters said the forecast does not depend on large bulk purchases from hospital networks.
Margins, Spending and Clinical Progress
Second-quarter gross margin was 66%, compared with 65% a year earlier, benefiting from a $2.9 million tariff recovery. The company reiterated its expectation for approximately 65% gross margin for the full year.
Operating expenses rose to $89.8 million from $73.9 million, reflecting investments in patient activation and market awareness, BPH platform innovation, and the WATER IV prostate cancer trial. PROCEPT reported a net loss of $26.9 million and an adjusted EBITDA loss of $11.3 million. Cash, cash equivalents and restricted cash totaled $231 million as of June 30.
The company raised its full-year operating-expense outlook to $355 million to $360 million and expects an adjusted EBITDA loss of $35 million to $30 million. Waters said PROCEPT still expects positive adjusted EBITDA in the fourth quarter at both the low and high ends of its revenue outlook.
On the commercial side, PROCEPT has launched direct-to-patient pilots in 18 U.S. markets using television, radio, digital and social-media campaigns. Wood said early indicators include increased website traffic, greater digital engagement and more patient interaction with educational resources, although he cautioned that translating outreach into procedures can take months because of hospital scheduling constraints.
The company also highlighted clinical and regulatory developments, including a strengthened American Urological Association recommendation for Aquablation in updated BPH guidelines. PROCEPT completed enrollment of 280 patients in its WATER IV randomized trial comparing Aquablation therapy with radical prostatectomy, with primary-endpoint results expected at the American Urological Association’s spring 2027 meeting. The company also received FDA investigational device exemption approval for WATER IV AS, a randomized study evaluating Aquablation against active surveillance in certain prostate cancer patients.
About PROCEPT BioRobotics (NASDAQ:PRCT)
PROCEPT BioRobotics, Inc is a medical device company specializing in the development and commercialization of robotic systems for the treatment of benign prostatic hyperplasia (BPH). The company's technology leverages precision robotics and real-time imaging to perform minimally invasive procedures, aiming to reduce patient recovery time and improve clinical outcomes compared to traditional surgical approaches.
The company's flagship product, the AquaBeam Robotic System, uses a high-velocity waterjet to selectively remove prostate tissue while preserving surrounding healthy structures.
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