@amishboy51

Technology and Technique

Aquablation: Employs a high-velocity, heat-free water jet guided by real-time ultrasound and robotic programming to remove obstructing prostate tissue.

HoLEP (Holmium Laser Enucleation of the Prostate): Uses laser energy to meticulously peel (enucleate) the entire inner adenoma block from the surgical capsule, akin to peeling an orange.

Sexual Function and Ejaculation
Aquablation: Superior rates of preserving antegrade (normal) ejaculation because the heat-free mechanism and robotic mapping protect the vital structures and ducts near the verumontanum.

HoLEP: Carries a significantly higher risk of retrograde ejaculation (dry orgasm) or loss of normal ejaculation due to the complete sweep of tissue at the bladder neck.

Efficacy and Prostate Size
Aquablation: Highly predictable and effective for small-to-very-large prostates, though extremely massive glands (>150 ml) can sometimes carry higher retreatment considerations depending on study parameters.

HoLEP: Considered the ultimate size-independent "gold standard" for massive prostates, completely clearing out tissue so that regrowth or secondary operations are exceptionally rare (<2%)