PROCEPT BioRobotics Q1 Earnings Call Highlights

Key Points

• Q1 revenue was $83.1 million (+20% YoY) with ~12,200 U.S. procedures (+30% YoY), and management reiterated full‑year guidance of $390–$410M revenue and 60,000–64,000 U.S. procedures.
• Pricing discipline lifted U.S. HYDROS average selling price to about $485,000 (a 14% QoQ increase); the company sold 49 U.S. HYDROS systems (including two replacements) and expects new system pricing of $450–$460k for the rest of 2026 while pushing the AquaBeam replacement program.
• Gross margin improved to 65% and management targets positive Adjusted EBITDA in Q4 2026 with cash of $249M; the company also secured key clinical/regulatory milestones including an EAU "strong recommendation" for Aquablation, FDA clearance for FirstAssist AI Gen‑2, and near‑complete WATER IV enrollment.

PROCEPT BioRobotics NASDAQ: PRCT reported first-quarter 2026 revenue of $83.1 million, up 20% year over year, as management pointed to early progress from organizational changes aimed at improving execution, pricing discipline, and profitability.

Chief Executive Officer Larry Wood said the company has taken “decisive actions to reset the organization” over the last six months, sharpening its focus on “operational excellence, accountability and commercial discipline.” He added that first-quarter results reflected “the early impact of these efforts,” while noting some short-term disruption tied to a commercial realignment that was finalized in early Q1.

Quarterly results and operating trends

Chief Financial Officer Kevin Waters said U.S. revenue was $72.0 million, up 19% from the prior-year period, while international revenue was $11.1 million, up 25%.

On procedure volume, both Wood and Waters reported approximately 12,200 U.S. procedures in the quarter, representing about 30% year-over-year growth. Wood said the company’s commercial realignment “modestly affected Q1 procedure growth,” but that performance was “largely in line with expectations,” with the “full benefit” expected to materialize in the second half of 2026.

Asked about quarter-over-quarter flat procedure trends, Wood attributed the pattern primarily to “normal seasonality” that the company typically sees at the start of the year and said it was “hard to quantify” the impact of sales force changes versus seasonality. He also said stronger system placements and the launch team model should contribute more as the year progresses.

Systems, pricing, and the replacement program

The company sold 49 HYDROS systems in the U.S., including two replacement systems, and ended the quarter with a U.S. install base of 765 systems, according to Waters. U.S. system revenue was $23.4 million, up 25% year over year.

Wood emphasized pricing discipline as a cornerstone of the company’s long-term strategy. He said first-quarter U.S. HYDROS system average selling prices were approximately $485,000, calling it “an all-time high” and a 14% increase compared with the fourth quarter of 2025, despite Q1 being “typically a seasonally challenging quarter for capital.” He added that the strength was broad-based, with no meaningful contribution from large IDN orders, which he said also supported the ASP outcome.

Management tempered expectations for the rest of the year, citing customer mix and a desire not to “get out over our skis,” as Wood put it. Waters said the company expects new U.S. system pricing to range between $450,000 and $460,000 for the remainder of 2026, depending on the mix between individual accounts and large IDNs. In response to an analyst question, Waters indicated this would put the full-year average “more towards the upper end, probably around $460,000.”

Wood also highlighted early traction in the AquaBeam replacement program. While only two replacement systems were included in the quarter’s 49 U.S. system sales, he said the company was “very encouraged” by the early start and expects replacements to be an area it “really hone[s]” in 2026 and “a much bigger part of our story in 2027.”

Handpieces and procedure pull-through

Handpiece sales represented about 95% of procedures in the quarter, with an average selling price of approximately $3,500, according to both Wood and Waters. Total U.S. handpiece and other consumable revenue was $43.0 million, up 13% year over year.

Wood said field inventory levels and customer purchasing behavior have “normalized,” and management maintained its expectation of roughly a 1-to-1 ratio of handpieces to procedures for the full year. Responding to questions about whether handpieces could remain below procedures, Wood said handpiece sales can fluctuate based on the number of systems launched, but that “eventually procedures and handpiece sales have to equalize out over time.”

Margins, expenses, and profitability goals

Gross margin in the first quarter was 65%, compared with 64% in the first quarter of 2025 and 61% in the fourth quarter of 2025. Waters said the improvement reflected increased pricing, cost discipline, and favorable product mix.

Operating expenses rose to $86.6 million from $71.6 million a year earlier, which Waters attributed to continued investment in commercial expansion, ongoing innovation in the BPH platform, and increased funding for the WATER IV prostate cancer trial.

The company posted a net loss of $31.6 million, compared with a net loss of $24.7 million in the prior-year quarter. Adjusted EBITDA was a loss of $18.1 million, compared with a loss of $15.8 million a year earlier. Waters said the company is working toward positive Adjusted EBITDA in the fourth quarter of 2026, and also noted that cash, cash equivalents and restricted cash totaled $249 million as of March 31, 2026. He said cash usage is expected to improve through the year as operating leverage and working capital improve.

On gross margin cadence, Waters said margins should expand modestly in Q2 and Q3 (by roughly 10 to 20 basis points in each of the next two quarters), and that the company expects to exit the year “in the 66%+ range,” while maintaining a full-year gross margin expectation of about 65%.

Clinical, regulatory, and international updates

Wood highlighted several clinical and regulatory developments discussed on the call:

• EAU guideline update: Wood said the European Association of Urology updated clinical guidelines in March to give Aquablation therapy a “strong recommendation” for men with BPH and moderate to severe LUTS, including as an alternative to TURP, particularly for those seeking to preserve ejaculatory function.
• U.K. HYDROS launch: Wood said the company completed the first international launch of HYDROS in the U.K., selling seven new systems in the quarter at an average selling price of over $400,000. He cited “rapid adoption at high volume NHS hospitals” and said the U.K. capital pipeline “continues to grow nicely.”
• FDA clearance for software: Wood said PROCEPT received FDA clearance for its second-generation FirstAssist AI software, describing it as advancing personalized image-guided planning for Aquablation therapy.
• WATER IV enrollment timing: Wood said the company is approaching completion of patient enrollment in WATER IV and expects full enrollment by the end of May. He said the company expects to present the WATER IV primary endpoint at AUA in spring 2027.

During Q&A, Wood also addressed reimbursement-related questions, saying the company has not built potential APC level changes into its modeling and is focused on clinical differentiation and operational efficiency for hospitals rather than trying to “chase” reimbursement changes. He added that any improvement in APC levels would be “an upside to reimbursement.”

Looking ahead, Waters reiterated full-year 2026 revenue guidance of $390 million to $410 million, which implies 27% to 33% growth versus 2025, and reiterated expectations for international revenue of $50 million to $51 million. The company also maintained its expectation of 60,000 to 64,000 total U.S. procedures for the year, representing 39% to 48% growth. For the second quarter, management guided total revenue to a range of $91 million to $95 million.

Wood said that while the company has undergone significant change, management believes the steps are “essential” to drive sustainable growth and establish a “clear path to profitability,” pointing to pricing discipline, a building U.S. capital pipeline, and ahead-of-schedule WATER IV enrollment as key factors discussed on the call.

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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