Leakage of water pipelines will significantly endanger safety operation and service performance of pipelines. Based on the vibration of pressurized water pipelines deriving from the leakage, the BA-FH3200 fiber optic hydrophone (FOH) leakage detection long-term detection system was adopted in prototype tests. The vibration-based real-time leakage monitoring method of the pressurized water pipeline were studied. During the test, the leakage was simulated by opening a spherical valve in the middle of the pipe, and a FOH was placed right above the pipe wall to detect the vibration signal along the pipe. The FOH analysis software was used to monitor the pipeline operation status in real time and acquire data. Then, the data was processed by a self-developed post-processing program, and the parameters were optimized through back calculation. The test results reveal that the leakage positioning error was lying between ±0.07 m, and the real-time monitoring (i.e., early warning alarm and leakage positioning) of the FOH for pressurized water pipeline was feasible.