Five BPH procedures are available at Seomyeon L Urology. The most important decision variable for sexually active men is ejaculation preservation: Aquablation 92%, Rezum 82%, UroLift 80%, TURP ~35%, HoLEP ~30%. For prostate size over 80mL, only Aquablation and HoLEP are suitable. Dr. Kim selects based on anatomy first, patient preference second — not on which procedure the clinic earns most from.
Procedure Selection by Patient Profile
Aquablation (AQUABEAM)
AI-guided waterjet ablation. Best ejaculatory outcomes of any ablative BPH procedure. Suitable for 30–150mL prostates. Only procedure that combines TURP-equivalent efficacy with ejaculation preservation exceeding 90%.
| Best for | Sexually active men, prostate 30–150mL |
| Ejaculation preserved | 92% |
| Large prostate (>80mL) | Yes |
| Stay in Busan | 5–7 days |
| All-in USD | $4,800–$6,200 |
UroLift System
Mechanical retraction of prostatic lobes using permanent implants. Shortest recovery of any BPH procedure. Same-day discharge; return to work week 1–2. Ejaculation preserved in ~80%. Not suitable for median lobe obstruction or prostates over 80mL.
| Best for | Prostate 30–80mL, shortest recovery priority |
| Ejaculation preserved | ~80% |
| Large prostate (>80mL) | No |
| Stay in Busan | 5–7 days |
| All-in USD | $3,800–$4,600 |
Rezum Water Vapour Therapy
Steam ablation of prostatic tissue. Good ejaculatory outcomes (~82%). Requires 2–7 day catheter — longer than UroLift or Aquablation. Better for median lobe than UroLift. Symptom improvement takes longer to plateau (4–8 weeks).
| Best for | Prostate 30–80mL with median lobe |
| Ejaculation preserved | ~82% |
| Stay in Busan | 5–7 days (catheter management) |
| All-in USD | $3,500–$4,300 |
TURP (Transurethral Resection)
Gold standard for 40+ years. Best symptom relief data. BUT: retrograde ejaculation in ~65% — semen enters the bladder at orgasm. Permanent. Appropriate for patients who are not sexually active or have already completed their family. Lower cost.
| Best for | Not sexually active; cost priority |
| Ejaculation preserved | ~35% only |
| Stay in Busan | 7–10 days |
| All-in USD | $3,200–$4,100 |
HoLEP Laser Enucleation
Most durable BPH treatment; lowest reoperation rate. Gold standard for large prostates (>80mL). Retrograde ejaculation ~70% — similar to TURP. Longer OR time; requires 1–2 nights. Recommended when Aquablation is not suitable (previous pelvic radiation, specific anatomy).
| Best for | Large prostate >80mL, durability priority |
| Ejaculation preserved | ~30% |
| Stay in Busan | 8–12 days |
| All-in USD | $4,200–$5,500 |
The Ejaculation Question — Why It Matters for BPH
Retrograde ejaculation (RE) occurs when the ejaculatory ducts are damaged during prostate treatment, causing semen to travel backward into the bladder rather than exiting at orgasm. The sensation of orgasm is usually unchanged — but the visible ejaculate disappears.
For men who have completed their family and are not primarily concerned with visible ejaculation, RE may be acceptable in exchange for a lower-cost or more established procedure (TURP, HoLEP). For younger men, men with a new partner, or men for whom ejaculation matters regardless of fertility: RE is not acceptable — and modern BPH procedures make it avoidable for most patients.
Dr. Kim's Procedure Selection Protocol
Confirm Prostate Volume (TRUS)
Volume determines which procedures are anatomically possible. Under 30mL: watchful waiting discussed. 30–80mL: all five procedures possible. Over 80mL: Aquablation or HoLEP only.
Assess Ejaculation Priority
Directly asked: "Is ejaculation preservation a priority for you?" If yes: Aquablation, UroLift, or Rezum. If no: TURP or HoLEP may be appropriate depending on size and cost preference.
Assess Recovery Window
How long can the patient stay in Busan? One week minimum: Aquablation, Rezum, or UroLift. If 10+ days available: HoLEP or TURP are also possible for appropriate cases.
Final Recommendation
Written recommendation with specific procedure, rationale, price quote, and stay duration confirmed before the patient books travel.
