How do I treat a large prostate without losing sexual function?

Aquablation is an advanced, robotic-assisted surgical procedure that treats an enlarged prostate (BPH) by using a heat-free waterjet to remove excess tissue. It is performed under anesthesia with no incisions, resulting in durable, long-term urinary relief while significantly reducing the risks of sexual dysfunction compared to traditional surgeries.How It WorksDuring the procedure, surgeons use a combination of a cystoscope and real-time ultrasound imaging to map out the exact size and shape of the prostate. A robotically controlled waterjet is then deployed through the urethra to precisely remove the tissue blocking urine flow, a step that usually takes just a few minutes. The heat-free nature of the water stream helps protect the surrounding nerves and anatomy that control sexual function and continence

Don't know if this helps . . .

Can I ask whether your doctor also suggested HoLEP surgery?

Understand, I’m not by any means advocating for it; it’s just that I’ve been unsuccessfully dealing with urinary retention for about 2 months now. After a cystoscope, my urologist recommended HoLEP over aquablation, so I was curious whether his preference is common.

@wrzakers What a great option! Do you know if Medicare covers any of the cost?

My urologist said that the procedure called prostate artery embolization has helped his patients. It is done by interventional radiologists. That is why some urologists will not recommend or even suggest a PAE. If it is not sufficient or regrowth occurs then more aggressive treatment is still acceptable.

It is my understanding HOLEP takes longer to get up to skill level. Acquablation can reduce very large prostate.

@heisenberg34 yes, medicare does, and if you have a plan g supplement, there should be no cost to you. i am 69 and had an aquablation done 3 months ago and peeing today just as good as the day after the procedure. but, i did get total RE. Still have sex, no diff at all, just no mess.

I had the UroLift procedure done 3 1/2 years ago with no sexual side effects. And I'm still peeing like a teenager!!
It was also covered by my Medicare supplemental insurance.

@mthomey Loss of sexual function covers lots of issues, perhaps you are referring to retrograde ejaculation? Aquablation is promoted as having the lowest odds of that but it is not zero. Most studies say 10% will have RE but after reading on this forum it seems higher. Many factors enter into this: age, weight, prior RE, meds, etc. With HoLEP RE is assured 99%. Other options have their own risk/benefits. Look at all the pros and cons before deciding. Don't just consider RE. Best wishes with the option you choose.

@soor Re: pros, am I correct that HoLEP involves a biopsy to rule out cancer?

@amishboy51 Yes a biopsy is done on the prostate "chips" that are the removed during HoLEP. It is one of the pros of this procedure. The large pieces of the prostate adenoma are pushed into the bladder then removed with a morcellator. These pieces are sent out for biopsy. The outer shell of the prostate is not removed so no biopsy is done in that area and unfortunately this area is where most prostate cancers are found so you can't say that cancer is ruled out. I don't believe that a biopsy is possible with Aquablation or some other BPH treatments. Thankfully my biopsy was negative. Thank you for asking.