Benign prostatic hyperplasia (BPH) Surgery Options

Dr Dora at Mayo Jacksonville. He has performed several thousand HoLep procedures

I had Holep in January 2025 and get up every 2 hours. Have random incontinence. Mayo Clinic Phoenix
I'll be 82 in 3 weeks might have something to do with my problem.

@rfherald I am hoping you are still checking this forum periodically. I had Rezum 5 years ago, did not work for me either. I chose Rezum because of the best chance for minimal side effects, and I indeed had few. Now considering HoLEP. Did yours work well? MY prostate was over 100 grams and my PSA is around 9.

I am 42 and had been on meds for bph for past 3 years. Taking tamsulosin 0.4 mg x 2 and Finasteride. I have been trying to avoid the surgery but had an episode of acute urinary retention and infection 3 weeks back. Had to go to the ER twice and bladder scan showed 700ml of retention. Had to be catherized. Off the catheter now.

Have contacted my urologist and thinking about scheduling the holep procedure.

@mandarin007 My advice is to make sure you get a second opinion. Also, there are usually more than one option for you, so do your homework and research your options. There are many Urologist out there willing to operate on you with some procedure, it’s really important to read, study, and be ready with questions. Write things down. There are many men in this Mayo Connect Group that have faced this exact problem. Go back and read their experiences and results.

I am having Aquablation next week. To me seems like the obvious choice. Curious why others still select Holep, Greenlight, etc.

@mandarin007
I just had a highly successful Holep on 19 June. Totally painless and uneventful recovery in my 6th week. But I would NOT recommend Holep for a 42YO because men at this age would still be likely be fathering children. Holep is best for those who are past fathering children because male fertility is 99% compromised. There is a modified Holep called “Part Holep” where the bladder neck tissue is left intact, to reduce the occurrence of retrograde ejaculation.

For a young man your age, I would recommend in this order:

1. P.A.E. (Prostate Artery Embolization - no prostate tissue removed, no risk of fertility loss from retrograde ejaculation

2. Aquablattion

Discuss with your urologist these 2 procedures. There is another new procedure (OPTILUME BPH) I came across today that is guaranteed NOT to compromise male fertility.: https://www.gaurology.com/optilume-bph/

@psblin99 Forget Greenlight. It is “outdated”in 2026. Holep is superior. I had Greenlight in 2012, but the prostate kept growing back, and hence I had Holep on June 19 this year. Painless and uneventful recovery. This is my 6th week, and from 4th week, I have returned to running after a 4 week ban, and today was my first day NOT wearing Depend! The most amazing aspect of Holep is totally pain free and blood free in the weeks after it. But I wouldn’t recommend Holep or Aquablation to younger men who are still fathering children. PAE and OPTILUME BPH are the only two prostate reduction procedures that can guarantee preservation of male fertility, hence ideal for men well below 50.

Between Holep, and Aquablation, the risk of retrograde ejaculation (male fertility loss) is about the same, and reading the experiences of those who had Aquablation, I can say my Holep experience is far less painful and easier, for the same risk of loss of male fertility.

@heath2026 Thanks for the info. At 73 I am going for the aqublation.

@mandarin007 I’m sorry for your issues. Any info as to why the Finasteride and tamsulosin weren't effective?

I ask because I’m 74, and my prostate is 124/133 grams. I’ve been on first Tamsulosin and now Alfuzosin for about four years. All was going well until I had general anesthesia during a routine outpatient surgery three months ago, which caused (post-operative) urinary retention.

I was too big a weenie to do self-catheterization, so instead had an indwelling catheter. After eight (yes) weeks of voiding trials (catheter out, catheter in), my doctor recommended HoLEP. Since I couldn’t get an appointment with the recommended surgeon for over a month, and I thought I was feeling some bladder sensation, I requested one more voiding trial. The following week, my bladder voided, with minimal retention.

I scheduled an appointment for a “second opinion” with another surgeon (who was able to see me sooner), & he endorsed a trial of finasteride, with no surgery unless & until I had another episode of retention.

Your situation at 42 might be completely different, but FWIW, I thought I’d share my experience. Good luck!