@markbph1 Do you have any regrets about your choice at this point?

My situation was a little different from yours. I’m 57, my PVR was lower at roughly 350 cc, and my prostate was considerably smaller, but I had a very obstructive intravesical median lobe that was essentially acting like a ball valve at the bladder outlet.

I did consider Aquablation. I actually thought about getting a consultation in the northern suburbs of Chicago, but once I had a long discussion with a urologist I trust deeply, I moved pretty firmly into the HoLEP lane. He is the chairman of a university urology department and, although he personally performs more traditional procedures such as TURP and Rezūm, he strongly encouraged me to look at HoLEP because he felt it was a very definitive option for the anatomy I had.

For me, that was the deciding factor. I wanted the most definitive solution I could get, especially with a large intravesical median lobe creating the obstruction. I ultimately went to Northwestern for HoLEP and have had zero regrets.

The retrograde ejaculation issue turned out to be a complete nothingburger for me. The orgasmic sensation and intensity are the same as before surgery, and I honestly do not care about the lack of visible ejaculate. Once I experienced it and realized that everything still felt completely normal, the psychological concern disappeared.

Everyone has different priorities, and I completely understand why preservation of ejaculation might push someone toward Aquablation. In my case, though, I wanted durability and definitive relief from the obstruction, and HoLEP has given me that. My urinary function is dramatically better, I’m off the alpha blocker, and I couldn’t be happier with the outcome. It has given me a lot back.