Aquablation vs. UroLift: Which BPH Procedure Fits You?

Quick answer: UroLift uses small permanent implants to pin enlarged prostate tissue out of the way. It's quick and usually done under local anesthesia. Aquablation removes the obstructing tissue with a robotic, heat-free waterjet. In a published meta-analysis of randomized trials in men with prostates under 80 grams, Aquablation produced greater improvement in symptom scores and urine flow, and its two-year retreatment rate was 4.3% compared with 7.5% for UroLift. Both procedures are known for protecting sexual function.

How does UroLift work?

UroLift is a prostatic urethral lift. Through a scope passed into the urethra, the urologist places small implants that act like tiebacks on a curtain. They pull the enlarged lobes apart to open the channel. No tissue is removed.

Because nothing is cut or heated, UroLift is often done in an office or outpatient setting with local anesthesia and light sedation. Many men go home without a catheter.

How does Aquablation work?

Aquablation physically removes the tissue causing the blockage. Dr. Tallman maps your prostate on real-time ultrasound and marks exactly what to remove and what to protect, including the bladder neck, the external sphincter, and the area tied to ejaculation. A robotic system then removes the targeted tissue with a high-velocity waterjet. There's no heat, so surrounding structures aren't exposed to thermal injury.

Aquablation is done under general or spinal anesthesia. Most men go home the same day or the next morning with a catheter for a day or two. Learn more in What Is Aquablation?.

Aquablation vs. UroLift at a glance

Which gives better symptom relief?

In an indirect comparison of randomized trials, the tissue-removing procedures (Aquablation and TURP) improved urinary symptom scores, quality of life, peak flow, and bladder emptying more than the non-removing procedures (UroLift and Rezum). A review in the Canadian Journal of Urology summarized the same analysis: Aquablation's improvement in peak urine flow averaged 6.3 mL/s more than UroLift and Rezum, and its advantage in bladder emptying held out to 24 months.

The analysis also found that UroLift's symptom improvement peaked around three months and declined gradually after that, while Aquablation continued improving through six months.

The reason is mechanical. UroLift reshapes the channel. Aquablation removes the obstruction. As the prostate keeps growing with age, tissue that's been removed doesn't come back in the same way.

What about sexual function?

This is where UroLift has built its reputation, and it's deserved. Both procedures avoid the high rates of ejaculatory loss seen with older surgeries like TURP.

The details: in the meta-analysis, UroLift men had better ejaculatory scores than Aquablation men at 6 and 12 months. Aquablation men kept improving after that point, which wasn't seen with the other two procedures. A separate analysis of the FDA trials found that both Aquablation and UroLift showed positive changes in ejaculatory function scores at three years. For the full picture, see Aquablation and Sexual Function.

How long do the results last?

At two years, retreatment rates in the meta-analysis were 4.3% for Aquablation, 4% for Rezum, and 7.5% for UroLift. Aquablation also has five-year randomized data showing durable results. Read How Long Does Aquablation Last? for the long-term numbers.

So which one should you choose?

UroLift may fit if your prostate is small to moderate, you don't have an obstructive middle lobe, you want the quickest possible recovery, and you'd prefer to avoid general anesthesia.

Aquablation may fit if you want the most complete and durable relief, your prostate is moderate to large, you have a middle lobe, or a previous minimally invasive procedure didn't hold.

The best way to decide is to have your prostate measured and talk through your priorities with a surgeon who performs these procedures regularly. Bring our list of 10 Questions to Ask Your Urologist.