WATER III: Aquablation vs. Transurethral Laser Enucleation of Large Prostates (80 - 180mL) in Benign Prostatic Hyperplasia

Inclusion Criteria:

1. Age: 45 - 80 years

2. International Prostate Symptom Score (IPSS) ≥ 8

3. Prostate size (measurement by transrectal ultrasound): 80 - 180 mL

4. Subject has diagnosis of LUTS (Lower urinary tract symptoms) due to BPH (BenignProstatic Hyperplasia)

5. Patient is mentally capable and willing to sign a study-specific consent form

6. Subjects with the ability to follow study instructions and likely to attend andcomplete all required visits

7. Written informed consent

Exclusion Criteria:

1. Body mass index ≥ 42

2. Suspected or history of prostate cancer

3. Suspected or history of bladder cancer

4. Bladder stone

5. Indwelling catheter for more than 3 months before baseline

6. Active urinary tract infection

7. History of urethral stricture or bladder neck stenosis

8. Damage of the external urethral sphincter

9. Previous prostate surgery or history of lower urinary tract surgery (e.g. urinarydiversion, artificial sphincter or penile prosthesis)

10. Use of anticoagulants (if medication cannot be stopped before and after procedure)or known coagulopathy (except ASS 100mg/d).

11. Contraindications for general and spinal anaesthesia

12. The investigator considers a pre-existing condition or the subject's lifecircumstances to be problematic for the conduct of the study and the completion ofthe follow-up investigations

13. Subject is unwilling to accept a blood transfusion if required

14. Subject is not able to give consent

15. Subject without legal capacity who is unable to understand the nature, scope,significance and consequences of this clinical trial

16. Simultaneously participation in another clinical trial in the field of urology

17. Known or persistent abuse of medication, drugs or alcohol