Aquablation: Post-surgery expectations

Hello @upstatephil. I'd like to invite @mvmjcp and @mike5450 to this conversation to share their outcomes after an aquablation. They talked about some of their outcomes here, https://connect.mayoclinic.org/discussion/orgasms-after-aquablation/.

@upstatephil, if you are comfortable sharing, what is your biggest concern you have going into your surgery?

Hi Justion. I don't have any great concerns. My research suggests a pretty straight-forward procedure with a high likelihood of success with little post-op downside. Sort of seems too good to be true? I'm just trying to gain perspective from those who've already done aquablation: did outcomes approximate what others have experienced?

I was retrograde from a previous procedure, so aquablation did not affect that, at least that I can tell.

I was able to ejaculate after remaining celibate for about 30 days after my procedure. Unfortunately, I have discovered that it now is much more difficult for me to reach orgasm than it was before the procedure. I, however, am not qualified to speculate whether that reflects causation rather than correlation.

Good luck, @upstatephil, with your procedure.

For anyone considering aquablation sometime in the future, I would suggest you also consider a PAE (prostate artery embolization). I had it done a little over a year ago and the results are amazing. They go into an artery in your thigh and up into you aorta and then down to the two arteries going to your prostate and place very small beads in them to block most of the blood going to the prostate. This is similar to placing stents going to the heart. I was in and out in half a day and had no after effects except that I no longer need to take two FloMax every day.

Thanks for that. I was hoping to learn some new stuff. Did you consider aquablation? If so, what made you chose PAE?

Forgive a dumb question … if you were already retrograde - how do you ejaculate? I understand having an orgasm but w/o ejaculate. I thought that was retrograde? But you still have ejaculate? Just trying to learn…thanks.

Very, very little semen. Rarely more than a little bead of it. The lack of ejaculate reduces intensity of the orgasm, but that might also just be aging.

No surgery to recover from. Making the prostate shrink instead of a roto rooter surgery was an easy choice for me. Urologists don't suggest this since it competes with their surgery. You need to go the physicians that do stents.

I had aquablation 1/30/2024 at the HCA Florida Northwest Hospital. I was taken into the operating room a few minutes after 9AM and was in recovery by about 1040AM. The actual waterjet lasted about 4 minutes. I was kept overnight for observation. During this time they ran big bags of fluid through my catheter. However, at one point the bag had run out and before it was replaced they had to flush out the catheter which was not fun. The whole time my urine bag was filled with a red color which had lighten somewhat by the time I was discharged. The time I experienced the most pain was when I had to urinate with the catheter in me. On Friday 2/2/2024, I went to the doctor to have the catheter removed. My urine was still red, but she said it was old 'blood' and that was fine. The tech then filled by bladder with fluid until I needed to urinate at which point she pulled out the catheter and I had to finish in a bowl that measured how much came out. The catheter removal was essentially painless.
I did need to use depends after the catheter since on at least 3 occasions when I got a strong urge I didn't make it to the toilet in time. Also it was only on the first of these that I ever saw anything like 'clots' in my urine.
Today is 2/7/2024 and my urine is basically clear. I've had no other pain other than with the catheter. I haven't had any morning erections as I've seen in other reviews. The doctor's report showed an 80gm prostate. I'm 80 years old and that might be the age limit for these procedures. Good luck with your procedure.

UPDATE: I went through aquablation on Monday 2/12. I stayed in the hospital (Mayo JAX) overnight afterwards for prostate flushing and observation. Went home 2/13 wearing a Foley catheter with travel urine bag in hand. I took it easy until 2/15 when the Cath was removed and I was instructed to drink about 50 oz of liquid in the next few hours. I returned that afternoon, urinated, and had an ultrasound to measure how fully I was able to empty my bladder. (The concern is the surgery puts the bladder on "pause" and they need certainty it has fully re-awakened) I passed the test and was fully released on 2/15 approximately 72 hours after the procedure.

The procedure itself was straight forward and non-painful. I never experienced any particular pain when urinating with the Foley catheter. With the catheter removed my urination pattern quickly returned to normal and I now feel (five days post) 95% of the way back.

At this point I am on activity restrictions for 3 1/2 more weeks. Intimate relations and heavy exercising will recommence on about 3/12.

In all, aquablation exceeded my expectations as far as discomfort goes. No real issues and my recovery followed the doc's plan perfectly. Time will tell if all prior bph symptoms are extinguished.