@tkohler I had Rezum several years ago. My prostate seems to have regrown. From a statistical standpoint does repeated Rezum often have merit or does HOLEP pose a likely better solution (my prostate was 100g initially.) I favored Rezum therapy because it presented the least likely chance of sexual side effects, and to that point I was satisfied, but lately I have read that HOLEP sometimes can be steered clear of the ejaculatory ducts rendering less chance of inhibition of orgasm.

@tkohler

Interesting information - thank you! A little thread drift here, but I hope for good reasons. I had very successful HOLEP surgery two years ago (I'm 61 now - small prostate but apparently filled with hundreds of prostate stones) and on the other side of it I've been paying attention to the men's health boards here for stories of what orgasms are like for folks who've had prostate surgery. My experience seems not uncommon - beyond the RE (which my wife is genuinely thrilled about), my orgasms have changed in a hard to describe way. At first it was just deceased pleasure - specifically the last second or two, sort of the early extinquishment of a firework just as it was getting going. Which was genuinely depressing. But over time the build up to orgasm became more intense, and the endpoint more of a full-body thing that's pretty satisfying. So: not worse anymore, just different. A little confusing in that it's less of one kind of pleasure but more of another.
My surgeon wasn't exactly interested in this story (I'm not sure I blame him) but my urologist says it's consistent with having the ducts removed. He said it's possible in HOLEP to keep them intact but that he doesn't do that because it's a place where problems can arise again.