Comparison guide · Prostate

HoLEP vs Aquablation vs GreenLight

Last updated: 9 June 2026 · Reviewed by Mr Sanjay Rajpal, Consultant Urological Surgeon · GMC 6106646

HoLEP, Aquablation and GreenLight are all treatments for urinary symptoms caused by benign prostate enlargement. The best choice is not simply the newest operation; it depends on prostate size, shape, bleeding risk, bladder function and personal priorities.

Practical summary: HoLEP is usually chosen for durability and larger prostates, GreenLight for vaporisation with low bleeding risk in selected glands, and Aquablation when robotic water-jet resection is a good fit for the anatomy and priorities.

HoLEP

HoLEP removes the obstructing inner prostate tissue with a holmium laser. It is size-independent and well suited to larger prostates or men who need a durable de-obstructing operation. Retrograde ejaculation is common because the operation removes tissue around the bladder neck and prostate channel.

Aquablation

Aquablation uses imaging and a robotically controlled water jet to remove planned prostate tissue. It may be attractive for men who want symptom improvement while considering ejaculatory preservation, although suitability depends on prostate anatomy, bleeding risk and local availability.

GreenLight laser

GreenLight laser vaporises obstructing tissue through a telescope. It can be useful for selected men, including some where bleeding risk matters. It may be less suitable for very large glands or anatomy where tissue removal rather than vaporisation is the more durable option.

Questions that decide the choice

How large is the prostate on imaging?
Is there a median lobe or unusual shape?
Is the bladder weak, overactive or obstructed?
Is preserving ejaculation a major priority?
Are blood-thinning medicines or bleeding risks relevant?
Is the patient in retention or catheter-dependent?

How to think about durability and side-effects

Durability usually means removing enough obstructing tissue to give a lasting channel. Side-effects depend on what is treated and how much tissue is removed. For some men, the strongest long-term flow is the priority. For others, preserving ejaculation or minimising time away from work carries more weight. The right choice is the one that fits the clinical problem and the patient's priorities.

Why a comparison page cannot choose for you

Online comparisons are useful for framing questions, but they cannot replace assessment. Prostate size, bladder function, PSA history, cystoscopy findings, anticoagulant use and previous procedures can all change the safest recommendation. A consultation should translate the options into a personal recommendation and explain why alternatives are less suitable.

What assessment involves

Assessment usually includes symptom scoring, PSA review, urine testing, flow rate, bladder scan, prostate imaging and sometimes cystoscopy. Mr Rajpal will explain which option fits the clinical picture and why an alternative may be safer or more effective.