LUGPA 2026 BPH CME Series-BPH Webinar 3

Video Transcription

Video Summary

The symposium focused on treatment strategies for large and very large BPH prostates, defined by AUA guidelines as 80–150 g and 150 g or larger. Four main options were reviewed: HoLEP, robotic water jet therapy (Aquablation), prostate artery embolization (PAE), and robotic-assisted simple prostatectomy.<br /><br />HoLEP remains highly effective for any prostate size and has excellent hemostasis, but it has a steep learning curve, can take longer for very large glands, and carries risks such as retrograde ejaculation and occasional incontinence. Aquablation offers fast, image-guided, ejaculation-sparing treatment with good outcomes in large prostates, though bleeding and insurance limits are concerns. PAE is minimally invasive and attractive for patients on blood thinners or those prioritizing sexual function, but its long-term durability is less certain. Robotic simple prostatectomy is durable and effective for very large glands, but it is more invasive and requires longer recovery.<br /><br />Comparative studies suggest HoLEP often provides the strongest functional outcomes, but patient priorities matter. The speakers emphasized matching treatment to prostate size, anatomy, bleeding risk, and especially the patient’s desire to preserve ejaculation.

Keywords

BPH

large prostate

HoLEP

Aquablation

prostate artery embolization

robotic simple prostatectomy

ejaculation preservation

minimally invasive treatment

symposium