The answer is both. Large tissue required an instrument done real time without any type of pain killer; unnerving to say the least. I also pass smaller bits when urinating. It's not continually but very much episodic. A recent MRI shows prostate calcification so believe that's what I am experiencing.
The remaining issue is that following a strenuous run there is substantial blood in the urine. I was put on Finasteride for 6 weeks and have a scheduled meeting with the surgeon the end of this month where they will do a scope. Other than the blood in the urine the aquablation did what it was intended to do; better flow, less awakening at night, less sense of urgency, etc.