I have a larger prostate over 100 grams with a large obstructing median lobe. Three years ago I explored my options. Even then i was thinking aquablation would be the way to go but my insurance did not cover it then. I had rezum done which worked for about a year and then had a second rezum that also worked for about a year. As my symptoms recently havevreturned i was happy to learn my insurance now covers aquablation, although i will have to travel for it. I have researched it heavily and am very hopeful it will provide lasting relief for my particular situation. The “crude” aspect of aquablation you mention is likely the fluffy “cotton candy” edge it can leave, however, that can be “cleaned up” in a few minutes using the tool used when doing a turp. That tool is also used to close off two veins that in the past sometimes caused bleeding issues. It’s the only use of heat during aquablation. The latest best practices that have been adopted have largely reduced the risk of needing a transfusion following aquablation. Recent studies show aquablation can provide durable results similar to turp, holep and pvp without the potential side effects associated with using heat to remove tissue. Im thinking by the time i would need another procedure they will have come up with something even better than aquablation.