Green light PVP vs HoLEP

I recently faced the same decision and narrowed my options to TURP, Aquablation, and HoLEP. After careful consideration, I ultimately chose Aquablation, and I’d be happy to share my reasoning with you. I had the procedure on January 24, so I’m currently four days post-surgery—and so far, I’m very pleased with the results.

Here are the main reasons I chose Aquablation:
• Precision and Technology: HoLEP is often described as having a steep learning curve for the surgeon, while Aquablation removes much of the human factor thanks to its robotic process. With Aquablation, the doctor uses a 3D ultrasound to map the prostate, programs the cut line, and then the system performs the procedure with precision.
• Outcomes and Studies: In all the studies I reviewed and conferences I watched on YouTube, Aquablation consistently performed as well as or better than TURP across all key outcomes. One significant difference was in preserving the ejaculation pathway: Aquablation outperformed both TURP and HoLEP in maintaining the semen pathway. I'm not really sure how important of a consideration that was for me, but it was certainly a plus for aquablation.

I’ve also shared a more detailed account of my experience four days post-surgery elsewhere on this forum, so feel free to look that up. If you have specific questions or want to hear more about the process from a patient’s perspective, I’d be more than happy to share.

Wishing you the best as you navigate your decision-making process!

I am 73 and was on Alfuzosin for more than 20 years. My kidneys were failing due to backed up bladder. My doctor told me that if I didn’t correct the BPH I may end up on dialysis if both kidneys fail. Kind of frightening. He does HOLEP and highly recommended that I do it due to my enlarged prostate. On Dec 3, 2024 I went through the procedure. Went home that afternoon and then after being home with the catheter, went to the emergency room when urine stopped flowing. The ER cleared the blood clot and I was good for nearly 3 weeks when I developed a UTI. Took the antibiotics and thought all was good but on 9 Jan 2025 I felt something moving down through my urethra while peeing. When the tissue got to the head of my penis it stopped moving. It stuck out about 1/4 inch so I grabbed it with a tissue and tried to pull it out. It wouldn’t budge. I went to the ER and the doctor did all he could to remove the clog but couldn’t get it out. He put in the smallest catheter in the ER and sent me home. My doctor was not available so I was stuck with this catheter until I could see him. After 5 days with the catheter I started leaking out of the penis and the clog disappeared from the tip. After 5 more days the clog was completely gone. A nurse at my doctors office removed the catheter and now I now longer have a UTI and I am back to trying to stop the incontinence. I am going through 6 to 7 diapers a day. The PT has me doing pelvic floor exercises everyday, but it doesn’t seem to be helping. If I am up moving I don’t hold any urine in my bladder. It all leaks out. If I am sitting or sleeping everything works as advertised. I can get up and empty my bladder. Last night I only got up 2 times to pee. Great flow and not a lot of leakage. Only use 1 diaper during the night time. I think I am the one off of everyone else that goes through HOLEP.

I'm one week out from my January 21, 2025 Holep. No pain, no burning at any time. One week out blood in urine has stopped. Night time leaking stopped two days ago. I'm a happy camper. 81 yo, prostate 201cc. Had been using a Foley catheter for 13 months. Had BPH for 20 years. Good luck.

Thanks, for the feedback, guys. Luckily I still empty OK, about a 100-125 cc residual, so no kidney issues. My issues are strictly quality of life but very annoying to say the least, especially at night. I am sleeping fine and then when I roll over suddenly I get that urge to pee. Again. Ugh. And I get by in the daytime, albeit with frequent trips to the rest room. All this on alfuzosin. Without the meds, forget about it.

I had read some other posts here about aquablation and I did find another doc near me that does that, along with HoLEP and a bunch of other "minimally invasive" BPH procedures. So, maybe I'll give him a visit for that second opinion and consider aqublation. My only concern with that it that it just seems to be TURP but with a water knife instead of a metal one. So, I wonder about bleeding and healing.

I have had both green light laser and HOLEP. I got several good years out of the green light procedure, but re-occluded and wanted to have more tissue removed so I would have less of a chance of re-occlusion and needing another procedure. I feel it is more important to get the best procedure for you than to have your surgery done locally. It could be very helpful to see a surgeon who can perform HOLEP to be able consider this against the light. I was not a good candidate for urolift and was not enthused about having another implanted device. Good luck. I think both procedures will offer good relief.

I'm 77 and had the HOLEP op (in NZ) about two years ago. Self cathetering for several months but at least I wasn't getting up multiple times a night and making a dash for the toilet during the day (I kept a Pee jar in the car!). Regular exercise and cutting down on Caffeine and alcohol helps. I'm fine now and can sleep through but usually get up at least once. The ejaculation pathway took a long time to clear but wasn't that big a deal. My brother (3 years younger in Australia) had the HOLEP op, which failed so he was given the TURP which seems to have worked.

I am now 9 weeks out from my HOLEP on Dec 3 2024. Incontinence continues even with the PT giving me exercises to do daily. The Kegal exercises don’t seem to be helping. I use 6 to 7 depends daily just as I did immediately after the procedure. I only use one depend during the night and last night only got up one time to pee. My depend is still pretty full when I wake up. The PT says to keep doing the Kegals. Anyone else have incontinence this long and feel as though the Kegals are not working. If so, what did you do to overcome the incontinence. I will see my urologist on 5 March and discuss the problems with him. Having to change my depends every 2 to 3 hours while up and moving around has been very difficult. I always wear shorts and have extra depends with me and run into a restroom to change out the depends. If I am up moving around I go all day long without going to the bathroom and peeing because I leak all the urine out into the depends. The only control I have is when I am sitting doing nothing or sleeping.

One man Dr. Austen Slade (Boise Idaho) just saved me 10 days ago. Everything works so far. Haven’t taken the final test to see what I can still do it all. Waiting 3 weeks more and proceeding with caution

10 days out from 1/31 procedure. So far no complaints or complications. Drinking loads of water to flush and not give my body a chance to build anything up inside. I’m mobile but not exercising. Walking too much seems to cause blood. As does drinking coffee or soda. Anything can irritate and slow down the healing process

Are you saying you don’t have incontinence? What I have read is that everyone has it for a while but most overcome it pretty quickly. I seem to be one that will be 6 months to a year to overcome my incontinence. As far as bleeding I never had any after the first couple of days. I walk 6 to 7 days a week and has never caused any issues or blood. Good luck with your healing and pray all goes well.