ml-HoLep or Aquablation?

Given the following information:

Which Procedure would you choose and why?

ml-HoLep: Removes only the median lobe

Full HoLep: Removes All

Aquablation: Removes what is required throughout the prostate with the aid of ultrasound

Patient

• Does not want any changes to his sex life:
• Age 63
• Physically fit
• On Daily Coumadin - Allowed to come off of Coumadin 3 days for surgeries

Prostate Characteristics:

• Hyperplasia - trilobar and median lobe present - Translation: median lobe which extends into the bladder

• Prostate - estimated length (cm): 3, size 55g

• Circumferential protrusion of prostate tissue with prominent moderate median lobe.

• Patient has complete obstruction. One clip appears to be starting to erode into the bladder but not inside yet.

• All other test results are normal

• Previous failed UroLift - never improved my condition. Performed on Lateral Lobes only

Surgeon's Skill Level:

• HoLep: Multiple years experience
• Aquablation: New to the procedure

Chances of Retrograde Ejaculation:

• ml-HoLep - Low
• HoLep - High
• Aquablation - Low

Travel

• 5 hour drive to and from surgery site

Advantages and Disadvantages

• HoLep:

• Less chances of prolonged bleeding and faster recovery than a TURP.
• Catheter overnight, removed the next day.
• No hospital stay
• Procedure results are surgeon dependent.
• Under general Anesthesia Longer than Aquablation
• Multiple cases to perfect technique

• Aquablation:

• Bleeding chances are higher than HoLep but less than TURP.
• Recovery faster than TURP.
• Catheter for a couple of days or more.
• At least 1 night in the hospital.
• Procedure has consistently repeatable results
• Shorter general Anesthesia time than with HoLep
• Easy learning curve

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