Aquablation: Post-surgery expectations

Hello all...new here. Aquablation scheduled 4/29/24. Had issues with not being able to urinate (at all) after anesthesia since 2/2010, after my first hip joint replacement. Also after 2nd (3/2011), and then after both shoulder joints (5/2020 & 9/2022). Also had the more common BPH symptoms, outside of anesthesia, but mostly minor and tolerable. Went on BPH meds (tamsulosin & finasteride) after the first shoulder joint and was catheterized for a week after 2nd (that's when I went to double daily dose of Flomax). My urologist had been suggesting TURP, but gave Urolift as another, much less preferred option (too high a likelihood of failure; he thought I'd likely need to have a TURP or back on meds anyway; neither he, nor the his hospital do Aquablation.) I didn't have either, as was urinating fine, meds were handling things. On 2/13/24, I had a hernia removed; I'd been urinating fine before that (and even went off meds awhile with no problems...which was great! ...even was able to ejaculate...a little). Both hernia surgeon and urologist thought I should be OK to urinate after the hernia, as was a more local anesthetic. Just before hernia surgery, I asked an anesthesiologist; she did not agree; she was pretty sure I'd have issues. She was right. I was able to pee...once...after surgery, and went home. Had to return to ER the next morning to be catheterized. I've been catheterized since 2/14/24. Instead of just having TURP (which my urologist thought was best), I asked another urologist, different hospital, for a second opinion. He agreed with the downsides of Urolift and TURP, and after research, I have decided on Aquablation...I discovered this support group today. Grateful for everyone's input. Sounds like a very mixed recovery experiences. I'm hopeful for a good outcome, but sounds like I should expect 4-6 weeks to full recovery. Any other suggestions on how to best cope after the procedure are welcome! I'll check in after...Thanks!

@garyinmontara - I am nine weeks post aquablation and am experiencing no issues at all. All the BPH symptoms are 100% gone. Zero negative effect sexually. Best of luck to you! Think positive thoughts.

Thank you Phil! Wonderful to hear. You've made my day. The waiting and concern about how things will turn out post-op are stressful. Originally supposed to have surgery on 4/15, but developed a bad UTI; my urologist elected to postpone to 4/29. I'm on antibiotics; my urologist thinks we should be able to proceed without issue as the infection should be gone by then. Thanks again Phil!

Like @snoopy48 I'm based in UK and 11 days ago underwent Aquablation surgery in the Candover Suite at Basingstoke & North Hampshire Hospital. There are still only a few places in the UK that carry out this procedure and although this Hospital is not local to me the cost (£9,080) was £3,500 less expensive than the London teaching hospitals and so this saving was obviously attractive. I would certainly recommend Candover as a good place to have this procedure done and my urologist, Prof. Richard Hindley, was excellent. (I was placed on an NHS waiting list late last year, but in view of the current length of NHS waiting lists had no confidence that I'd be called any time soon...)

As a 70 year old I've experienced urinary 'issues' for a number of years and 2 years ago underwent Botox injections as my urologist considered my urine flow to be adequate. This opinion was based on misleading urodynamic test results and Botox proved to be totally ineffective. In fact it made matters worse and my number of overnight trips to the bathroom was becoming totally intolerable...

Following further tests and a cystoscopy it was evident that I was suffering from BPH, was not a suitable candidate for Urolift (which I favoured) due to a median lobe and therefore decided to opt for Aquablation as I was attracted to it being 'minimally invasive'. My prostate was medium sized at 62gms.

The procedure was initially scheduled for last February, but was cancelled one week before my appointment date due to late delivery of equipment to the hospital. This was obviously very disappointing.

I'm on blood thinners and was told to stop these 3 days before my procedure. This is a difficult balancing act between the risk of getting further DVT and substantial bleeding resulting from Aquablation.

I attended a pre-op. assessment at Candover Clinic 8 days before my surgery appointment and the procedure was carried out without incident with copious and constant bladder flushing throughout the day/night. I was discharged the following day with a catheter which was (painfully!) removed at Candover Suite 3 days later. It does appear that many urologists (mainly in the USA) carry out TWOC before discharge. The 3 days with the catheter in situ were VERY uncomfortable with excruciating pain experienced every time when urinating and I was greatly relieved to have it removed! Urinating without the catheter was initially difficult, but eventually I was able to do so to the satisfaction of the urology nurse and so didn't need to have it re-inserted - thank God!...

Since then I've experienced no pain, but my urine has been pretty bloody at times. My urologist feels that this is 'normal', but as I'm on blood thinners they may be contributing to this situation and I've been advised to stay off the thinners for a few days to see whether this improves matters.

My urologist has also advised me not to do any physical exercise for 4-6 weeks, but this seems unnecessarily cautious and I may be tempted to do a light gym session after 3 weeks or so if my urine is clear and I'm experiencing no other symptoms (i.e. pain)

To date I've experienced no benefits from Aquablation, but I recognise that it's still very early days so I'm looking forward to some (hopefully!) substantial improvements in my urinary frequency - particularly overnight!

I hope this is of some use to anyone contemplating Aquablation, particularly in the UK. I always believed it to be the 'least worst' option for tackling BPH. Hope I'm right! I'm happy to try and answer any queries.

@geoffpuma999 - Thanks for sharing your very complete description of your aquablation experiences to date. 11 days is very early to experience all the benefits of the procedure and I would expect steady improvement in the weeks to come. Best of luck to you and please be very cautious about pushing the timing to return to regular activity...

It's now been five weeks since I had my aquablation done in Northern Virginia. I'd say at this point the jury is still out as to its effectiveness. I never had any blood clots, but it was almost four weeks before I didn't see any noticeable blood in my urine, and I had a burning sensation almost that entire time. On the other hand, I never had any pain, nor was it necessary to rush to to the toilet like others have experienced.

I began working out and having sex around the three week mark, but honestly I likely could have started lifting weights even sooner. (Not sure about starting sex earlier though!) My doctor still has me on Flomax for at least another week (I was supposed to have my follow up appointment today but he had to postpone until next week) so I am still experiencing retrograde ejaculation often, but I'm hoping that once I'm off Flomax that will reverse.

My urine flow is much improved post-aquablation, and I find that I'm not straining to start nor am I having fits and starts and post-urination dribbling. However, I am still having to urinate quite often, and am still getting up an average of twice a night even though I've stopped drinking anything after 7 p.m. My frequent urination is likely due to the fact that I have to drink plenty of fluids since I am a lifelong kidney stone sufferer. I did notice that when I had to travel for work last week and had less access to water (and bathrooms) I didn't have to urinate for a good 2 1/2 to 3 hours.

All in all, I think aquablation was worth it for me. I think everyone's experience will be slightly different. For me, the procedure was a breeze, and the only downsides were having to keep a catheter inserted for four days after and blood/burning in the urine for a month or so. I honestly felt like I could go back to normal activities a couple of days after the procedure, but followed doctor's orders (which were pretty lenient to begin with.

Wishing everyone good health. Happy to respond to any questions!

I am scheduled for Aquablation at the Georgetown hospital. My Urologist said I will be able to go home the same day and remove the catheter the following day. Based on other's experiences, does this sound realistic? In talking with another Urologist that does the procedure this is the norm.

@jgman - My experience (Feb 2024) was slightly different. One night in the hospital for observation, discharged for two days at home with a catheter, then return for catheter removal and final testing. I can't weigh-in on your post surgical instructions - but I do know aquablation is so new the science on immediate post-surgery is not fully settled...hence, some small differences from doctor to doctor.

Hello, neighbor (I'm in Arlington, VA). Every case is different, but this doesn't sound realistic to me. After my procedure at Virginia Hospital Center, they were running fluids through me all night and changing bags every couple of hours or so. I think that is pretty standard procedure. It seems like at least some people walk out of the hospital without a catheter, but I wasn't able to empty my bladder sufficiently the day after the aquablation so I had a catheter re-inserted and it stayed in me for four days. If your insurance will cover it (and it probably will) I would try to stay in the hospital overnight just to make sure everything is working properly. I didn't get much sleep that night since they were constantly checking up on me, but it was worth it. Good luck!

Thanks for the responses. I will inquire about the overnight stay and removal of the catheter. Perhaps the size of my prostate (only 32cc) has something to do with the decision to do outpatient and next day removal of catheter.