HoLEP vs Aquablation, which is better?

@amishboy51

While I’m hopefully waiting for replies, two other questions occurred to me:
1-did your urologist recommend one procedure over another?
2-also, did anyone seek a second opinion before proceeding?

I’m a little concerned because I’m starting to feel as if my urologist isn't very “forthcoming” in terms of information and advice.

I've been to 3 Urologists, first one says Urolift procedure, second one from respected Midwest hospital says HOLEP, third one offer's 4 different procedures and it's up to me to decide. says prostate is too small for PAE to work.
I'm totally confused.

@amishboy51 I found that urologists are not forthcoming - to me most of them just recommend what "they" do instead of looking at each individual holistically and determining the best course of action based on your specific situation. This makes it very difficult to a patient to make a decision. I made some mistakes already as a result. It was a toss up for me between Aquablation and HoLEP - I chose HoLEP and still don't know if I made the right decision. It also depends on your age and level of sexual activity for many trying to decide.

@amishboy51 Urologist do not bring up PAE because they don't do them, and they want to make money. A lot has to do with the size of your prostate and the anatomy. Median lobes are a real problem for PAE, otherwise that's the direction I would have taken, Unfortunately I am wasn't a good candidate for it. I would get some imaging done (MRI) that's the first step

@markbph1 Thank you for both of your detailed replies. I especially appreciate “I found that urologists are not forthcoming” and “A lot has to do with the size of your prostate.” To illustrate, my urologist has never mentioned my prostate size, let alone specified the figure.

I know I'm late to the game, but I wanted to share my experience with HoLEP.

I'm 71 and healthy, but I was getting up three to four times a night to use the bathroom. For years, I had been struggling with my PSA bouncing all over the scale. I had three prostate biopsies using a method that takes the MRI results and maps them to the prostate during the procedure to target the suspect areas. Every biopsy came back negative.

After talking with my urologist, he recommended HoLEP because the size of my prostate was 120 mL, and I was retaining 50% of the urine in my bladder when I attempted to empty it. My doctor warned me that this could eventually lead to bladder stones.

On April 28 of this year, I had the HoLEP surgery. The procedure started at 7:30 a.m., and I was able to go home the same day at 6 p.m. My catheter bag showed very little blood, so my doctor thought it was okay for me to go home with the catheter and leave it in for five days. Five days because I had previously had bladder-emptying issues that required a catheter.

Catheters suck, no two ways about it. But after five days, the catheter was removed, and I was peeing 100% better. The difference was amazing. I did struggle with blood in my urine for five weeks, but my doctor said it could take up to eight weeks.

Here I am, three months post-op, and everything is good. I just had my PSA tested, and it was 0.3! I still get erections, but I do experience retrograde ejaculation. That's okay, given my age.

I now get up once a night to pee, and on some days I sleep through the night.

I'm thrilled with my decision.

@jimcha Glad to hear your good report. Do you know your "updated" prostate size? I'm considering ho-lep for my 114 cc prostate so that I have more, better treatment options for my PCa.

I just heard a radio advertisement for Aquablation.com. It was basically saying how superior it is and touting the procedure. This may or may not be the case, every individual has different needs. Medical device companies are like the wild west and not highly regulated. It may be a great way to treat BPH, I just hate to see corporations pushing procedures for profit.

@amishboy51 I researched on my own. Since I had Greenlight in 2012, I had previously done alot of researchon BPH reduction procedures. In 2012, I had decided no way to TURP, the then "gold standard".

In 2026, I again researched extensively. There are many more newer procedures since 2012. 3 years ago, I almost had a "urolift" but I am glad I didn't. It wouldn't have suited my regrown prostate (from the Greenlight 2012). One thing urologiusts don't do is discuss many different types but they usually promote their area of expertise. By the time I decided Holep is my preference it was merely a matter of seeking out the expert and that was how I came into contact with Dr. Kapil Sethe, who has been pioneering Holep. Back in 2012, I recalled reading about Holep, but it was very new at that time.

So by the time I had sought out the urologist I wanted to see, I had compiled some basic questions to ask him, and it was easy for me to decide to go ahead - within less than a week. My 1st consultation with urologist was early June, and I had the Holep on June 19.

Haven't looked back. The recovery is UNEVENTFUL and without drama. There has been a total absence of pain at any level. It has been so easy to forget that I had a "procedure" 8 weeks ago. My urologist did tell me last week on my reviewe appint - I am his text book patient and he uses my recovery as his teaching example to other urologists. I emailed him a chart/ table showing the progression of my recovery over the first 6 weeks. The chart basically mapped out some distinct phases of discovery (which was very uneventful). I could easily just divide the 6 weeks into 2 phases - the phase of clear urine and the very short phase of some (very little) coloration (days 18-22) when the inner prostate surface shed its scar tissues. Going from pure clear urine to some slight coloration (microscopic scar tissue) is easy to see!

The only remaining healing aspect is bladder continence - it is 90% perfect, not yet 100%. But this is normal, and considered very good. I no longer wear Depends during the day. I used 2 Depends (level 3) for the first 25 days, thereafter only as needed. It will probably be 6 months before I achieve 100% bladder continence.