For men with large prostates, HoLEP (holmium laser enucleation) and Aquablation are the two most capable options on the table. Both remove obstructing tissue. They differ in how, how fast, and what they cost you in side effects.
How Each Works
HoLEP uses a holmium laser to enucleate the prostate adenoma off the surgical capsule, then morcellates the tissue for removal. It's thorough and durable.
Aquablation uses a heat-free, high-velocity waterjet guided by real-time ultrasound and controlled by a robot, following a surgical map the urologist draws before treatment begins.
Operative Time
HoLEP operative time scales with prostate size and surgeon experience, large glands can take a couple of hours. Aquablation's resection is measured in minutes and stays consistent regardless of gland volume.
Sexual Side Effects
This is the most practical difference. Retrograde ejaculation is expected in most men after HoLEP. Aquablation's treatment plan is explicitly designed to spare the structures involved in ejaculation, and reported rates are far lower.
Learning Curve and Availability
HoLEP has a long, well-documented learning curve, which limits how many surgeons offer it well. Aquablation's robotic execution standardizes the resection, though surgeon planning and case volume still matter significantly.
Choosing Between Them
- Maximum tissue removal and you're not concerned about ejaculation? HoLEP is excellent.
- Want strong flow improvement while preserving ejaculatory function? Aquablation is the stronger fit.
- Either way: pick the procedure your surgeon performs frequently, not occasionally.