Aquablation vs. HoLEP: Which Prostate Treatment Best Preserves Sexual Function?

Home > Aquablation vs. HoLEP: Which Prostate Treatment Best Preserves Sexual Function?

For many men exploring treatment for benign prostatic hyperplasia (BPH), preserving sexual function is just as important as finding relief from symptoms. Concerns about erectile performance and changes in ejaculation play a major role in deciding when and how to move forward with care.

Among today’s most advanced options, Aquablation and HoLEP both offer effective, minimally invasive solutions, but they differ in how they may impact sexual function. Here, we will take a closer look at how each treatment compares, so you can make a more informed, confident decision based on your personal goals.

What is Aquablation Therapy?

Aquablation therapy, offered exclusively at BPH Canada’s clinic in Montreal, is an advanced, minimally invasive treatment for BPH that uses a heat-free, high-pressure waterjet to remove excess prostate tissue. As the leading provider of this technology in Canada, we utilize Aquablation’s unique combination of robotic precision and real-time imaging. This allows our surgical team, led by Dr. Kevin Zorn, to provide a highly controlled, personalized approach that prioritizes both symptom relief and the preservation of sexual function.

One of the defining advantages of Aquablation is its focus on preserving structures involved in sexual function, particularly those responsible for ejaculation. Since the treatment is image-guided and avoids thermal energy, surgeons can more precisely protect key anatomical areas.

Here is how Aquablation can support sexual function:

Higher likelihood of preserving ejaculation: It’s designed to avoid critical structures near the bladder neck and ejaculatory ducts, and it helps many patients maintain antegrade ejaculation (normal, regular ejaculation).
Heat-free technology: It uses a waterjet instead of laser energy, and it may reduce the risk of unintended damage to surrounding nerves and tissues.
Image-guided precision: Real-time ultrasound allows surgeons to map and tailor treatment, and it helps minimize impact on areas linked to sexual function.
Strong erectile function outcomes: Low rates of erectile dysfunction have been reported, and most patients maintain the ability to achieve and sustain erections.

Overall, Aquablation offers an effective balance between symptom relief and the preservation of sexual function, making it an appealing option for men who place a high priority on maintaining ejaculation.

What is HoLEP?

HoLEP (Holmium Laser Enucleation of the Prostate), is a well-established, minimally invasive surgical treatment for BPH that uses a high-powered holmium laser to remove obstructive prostate tissue. It has been widely adopted for its ability to treat prostates of almost any size, including very large glands, with durable, long-term results.

HoLEP has a strong safety profile when it comes to sexual health, particularly erectile function. Here is what patients should know:

Erectile function is typically preserved: Most men maintain the ability to achieve and sustain erections, and low rates of postoperative erectile dysfunction.
Higher likelihood of ejaculatory changes: Retrograde ejaculation is relatively common after the procedure (this is when semen flows backward into the bladder instead of exiting normally). This happens because tissue removal near the bladder neck can affect the muscles involved in directing semen outward. This is a known and expected outcome of many effective BPH surgeries.
Sexual satisfaction is usually maintained: Orgasm and sensation are generally unchanged. The primary difference is the absence or reduction of visible ejaculation.

Overall, HoLEP remains a highly effective and durable treatment option, with reliable preservation of erectile function, while patients should be aware of the higher likelihood of changes in ejaculation.

Aquablation vs. HoLEP: Sexual Function Comparison

When comparing Aquablation and HoLEP, it’s important to understand that both procedures are highly effective at relieving urinary symptoms, and both are considered safe in terms of overall sexual health. In terms of erectile performance, both procedures have a strong track record of preserving it, and have reported low rates of postoperative erectile dysfunction.

As previously described, the key difference lies primarily in how each approach may affect ejaculatory function. With Aquablation, there is a higher likelihood of preserving antegrade ejaculation, and with HoLEP, It is more commonly associated with retrograde ejaculation.

It is important to emphasize that these differences are not about one treatment being “better” than the other. Instead, they reflect different surgical approaches and priorities:

Aquablation may offer an advantage for men who place a high priority on preserving ejaculation
HoLEP offers exceptional long-term symptom relief and is effective across a wide range of prostate sizes

In fact, in a 2025 study conducted by the Investigative and Clinical Urology that compared the clinical outcomes of Aquablation and HoLEP, the results from the 104 patients studied indicated that both are effective surgical options for BPH. While Aquablation offered superior ejaculation preservation, HoLEP provided better deobstructive efficacy. For many patients, the right choice comes down to personal priorities and a detailed discussion with a specialist.

Aquablation & HoLEP: Effective Treatments Offered at BPH Canada

Aquablation and HoLEP are both advanced, highly effective treatments for BPH, each offering relief from symptoms with a strong safety profile for erectile function. The main distinction lies in ejaculatory outcomes, with Aquablation offering a greater likelihood of preservation and HoLEP providing exceptional durability across a wide range of prostate sizes.

Ultimately, the right choice depends on your unique anatomy and individual treatment goals. By consulting with our world-renowned urologist, Dr. Kevin Zorn, you can explore these options in detail and choose a path that aligns with both your long-term health needs and your quality of life. Take the next step toward lasting relief and book a consultation with BPH Canada today.