Aquablation or UroLift:
the honest comparison
These two sit at opposite ends of the invasiveness range for an enlarged prostate, and both preserve sexual function far better than TURP. Dr. Sawkar offers both: UroLift in his Santa Ana office, a UroLift Center of Excellence, and Aquablation at Providence St. Joseph Hospital, where he has performed more than 250 cases, the most in Orange County. Which one fits is mostly a question of how large the gland is and how much disruption you are willing to accept for a more definitive result.
Medically reviewed by Hari Sawkar, MD, board-certified urologist · Updated September 2026
Side by side
Two different philosophies: UroLift holds the enlarged lobes apart with small implants and removes nothing; Aquablation removes the obstructing tissue outright with a robotic waterjet. One is an office visit and the other is a night in the hospital, and the size of the result tracks the size of the procedure.
| Aquablation | UroLift | |
|---|---|---|
| How it works | A heat-free robotic waterjet removes the obstructing tissue in one session | Tiny permanent implants hold the enlarged lobes apart; nothing is removed |
| Setting | Hospital, usually one night | Office visit |
| Anesthesia | Spinal or general | Local anesthetic with light sedation |
| Catheter | One to two days | Usually none |
| Back to routine | One to two weeks | Two to three days |
| Prostate size range | Proven from 30 to 150 cc | Up to about 80 cc; an obstructing median lobe can be treated with the MedLift technique |
| Ejaculation | Preserved in roughly 9 in 10 men in the WATER trial | Preserved in essentially all men in the L.I.F.T. trial |
| Result timeline | Evident once the catheter is out | Within about two weeks, as swelling settles |
| Durability | The most definitive of the minimally invasive options; about 1 in 20 men needed a repeat procedure within five years in the WATER trial | About 1 in 7 men needed retreatment within five years in the L.I.F.T. trial |
| Implants and MRI | No implants, nothing left behind | Implants stay in place; they are MRI-conditional and cause a small artifact on future prostate MRI |
General patterns, not a promise. Your measured anatomy, health, and goals decide, which is exactly what the consultation is for.
How men actually choose
Choose UroLift when the office is the point
Your gland is small to medium, you want no catheter and no hospital, you need to be back at work in days, and you want the surest bet on keeping ejaculation exactly as it is. UroLift asks the least of your calendar, and it closes no doors if you ever want more later.
Choose Aquablation when the gland is large or the blockage is severe
Your prostate is past the size UroLift handles well, or your symptoms are severe enough that a lighter procedure is unlikely to be enough. You want the most definitive single treatment, and a night in the hospital is an acceptable price for obstructing tissue that is simply gone.
Let the measurement referee
Prostate volume, whether a median lobe is pushing into the bladder, and how well the bladder itself is still working all weigh in. An in-office ultrasound turns this page's generalities into your specific answer, usually at the first visit.
Common questions
Which works better, Aquablation or UroLift
Aquablation produces the larger and more durable symptom improvement because tissue is removed; UroLift produces a smaller improvement with a much lighter footprint. For a 40 cc gland with moderate symptoms the difference may not matter; for a 100 cc gland with severe blockage it decides the question.
Can UroLift be done if I have a median lobe
Often yes now. The MedLift technique treats an obstructing median lobe in glands up to about 80 cc, which used to rule UroLift out. A quick cystoscopy and ultrasound settle whether your anatomy qualifies.
Which preserves sexual function better
Both preserve erections, and both preserve ejaculation far better than TURP. UroLift has the cleanest record, with essentially no ejaculatory change in the trial; Aquablation preserved ejaculation in roughly 9 in 10 men.
Can I have UroLift first and Aquablation later
Yes, and it is a common sequence. If symptoms return years later, the implants do not prevent Aquablation or other surgery; they are simply removed or bypassed during the procedure.
Get the answer for your anatomy
One practice, both procedures, no thumb on the scale. Same-day and next-day appointments, telehealth available, Medicare and most PPO plans accepted. For the fastest response, send the office a secure message; the reply comes back by text.
Chief of Urology, Providence St. Joseph Hospital · UroLift Center of Excellence · 250+ Aquablation procedures, the most in Orange County