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HoLEP vs Aquablation, which is better?

Posted by cardscrazysteve @cardscrazysteve, May 10, 2025

I’m schedule for a HoLEP in July in Rochester Mayo and am wondering if I made the right choice vs Aquablation. I am 67 and don’t care about ejaculation but worry about side effects, incontinence, pelvic exercises and getting quick results. I forgot is Aquablation an overnight stay?
I do want permanent results. I don’t want to go through this again. Thanks for your responses.

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amishboy51 | @amishboy51 | 1 day ago
In reply to @amishboy51 "Good morning. I don’t know if this thread is still active, but if so, thanks for..." + (show)
Profile picture for amishboy51 @amishboy51

Good morning. I don’t know if this thread is still active, but if so, thanks for welcoming me to this club I didn’t want to join. 😁

Anyway, here are my details: 75 in a few months, married; diagnosed w/BPH years ago, on Tamsulosin and now Alfuzosin for ~5 years; long history of elevated PSA, but no cancer, knock wood.

Had surgery 2 months ago to remove growth from back, bladder didn’t function, & on catheter since, with mixed results (voiding but not emptying). I think initial diagnosis of “post-operative urinary retention” has now been “abandoned.”

After UTI cleared, I finally had cystoscopy yesterday that showed “clean” bladder. Urologist recommends HoLEP rather than aquablation (no mention of PAE).

Thoughts, comments, etc.? Thanks in advance.

Jump to this post

@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.

REPLY
1 reply
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robert5167 | @robert5167 | 23 hours ago

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.

REPLY
Profile picture for markbph1
markbph1 | @markbph1 | 23 hours ago
In reply to @amishboy51 "@amishboy51 While I’m hopefully waiting for replies, two other questions occurred to me: 1-did your urologist..." + (show)
Profile picture for amishboy51 @amishboy51

@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.

Jump to this post

@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.

REPLY
Profile picture for markbph1
markbph1 | @markbph1 | 22 hours ago
In reply to @amishboy51 "Good morning. I don’t know if this thread is still active, but if so, thanks for..." + (show)
Profile picture for amishboy51 @amishboy51

Good morning. I don’t know if this thread is still active, but if so, thanks for welcoming me to this club I didn’t want to join. 😁

Anyway, here are my details: 75 in a few months, married; diagnosed w/BPH years ago, on Tamsulosin and now Alfuzosin for ~5 years; long history of elevated PSA, but no cancer, knock wood.

Had surgery 2 months ago to remove growth from back, bladder didn’t function, & on catheter since, with mixed results (voiding but not emptying). I think initial diagnosis of “post-operative urinary retention” has now been “abandoned.”

After UTI cleared, I finally had cystoscopy yesterday that showed “clean” bladder. Urologist recommends HoLEP rather than aquablation (no mention of PAE).

Thoughts, comments, etc.? Thanks in advance.

Jump to this post

@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

REPLY
1 reply
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amishboy51 | @amishboy51 | 15 hours ago
In reply to @markbph1 "@amishboy51 Urologist do not bring up PAE because they don't do them, and they want to..." + (show)
Profile picture for markbph1 @markbph1

@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

Jump to this post

@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.

REPLY
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