HoLEP vs UroLift, Rezūm and Aquablation

Why this comparison matters

HoLEP is an enucleation. It removes the adenoma. Symptom relief is deep and durable.

UroLift, Rezūm, and Aquablation are different by design. UroLift implants pull prostate tissue aside, while Rezūm uses steam to kill tissue the body then reabsorbs. Aquablation uses a water jet to remove tissue under imaging guidance.

The choice between them depends on prostate size, ejaculation priorities, and the man's tolerance for retreatment.

UroLift

UroLift places small implants that hold prostate tissue aside. Nothing is removed.

The procedure is fast and often avoids a catheter. Sexual function, including ejaculation, is well preserved.

Symptom relief is real but typically smaller than with enucleation. Retreatment over several years is more common than after HoLEP. UroLift suits smaller glands without a significant median lobe.

Rezūm

Rezūm delivers brief pulses of steam into prostate tissue. The body reabsorbs the treated tissue over weeks.

A catheter is usually needed for a few days. Symptom relief builds over about three months.

Ejaculation preservation rates are high. Durability is moderate; some men need further treatment after a few years.

Aquablation

Aquablation uses a high-pressure water jet under ultrasound guidance. A robotic arm steers the jet along a plan the surgeon approves.

It handles larger prostates than UroLift or Rezūm. Ejaculation preservation is better than with TURP, and sexual function is usually preserved.

A 2026 prospective partially-randomised trial — WATER III — compared Aquablation with transurethral laser enucleation for LUTS due to BPH[¹]. Both gave substantial symptom relief. The trial highlighted differences in perioperative profile and sexual outcomes, and its results will continue to shape the conversation over time.

Where HoLEP pulls ahead

HoLEP removes more tissue than the alternatives listed above. The capsule plane allows complete enucleation across a wide range of sizes in experienced hands.

Long-term symptom relief tends to be deeper. Retreatment rates are low. Men with very large glands benefit particularly — enucleation is the endoscopic option that scales to 300 millilitres.

Where the short-recovery options pull ahead

UroLift avoids any thermal injury. Return-to-work is fast, and sexual function stays close to baseline.

Rezūm has a good sexual-function profile, short procedure time, and can be done under light anaesthesia.

Aquablation preserves ejaculation better than TURP and handles moderately large glands.

Ejaculation matters for many men

Retrograde ejaculation after HoLEP and TURP is common. Ejaculation-preserving HoLEP techniques aim to reduce this rate, but availability varies.

UroLift, Rezūm, and Aquablation have higher ejaculation preservation rates than TURP in published reports. For a man who values ejaculation highly, this is a real factor.

What the evidence does not yet settle

Head-to-head trials across all four techniques are limited. Many comparisons are between pairs, and follow-up lengths differ.

Aquablation has the thinnest long-term evidence base of the four. Its five-year and ten-year durability are still being characterised.

This is why professional bodies recommend shared decision-making. Your preferences, your gland, and your surgeon's experience all matter.

What to ask

Ask how many cases of each technique your surgeon performs each year. Ask what their own rates of retreatment are at five years.

Ask about ejaculation and erectile function outcomes. Ask about the expected catheter time.

Written numbers are easier to compare than memory.

Plain bottom line

UroLift, Rezūm, and Aquablation offer short-recovery routes for men with suitable anatomy who value ejaculation preservation. HoLEP offers durable, size-scaling relief at the cost of a slightly longer recovery and a common retrograde-ejaculation change.

The right technique is chosen with your clinician after a full conversation.