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Aquablation: Post-surgery expectations
Men's Health | Last Active: 5 days ago | Replies (123)Comment receiving replies
Hi Phil. I am 64 and have had BPH since my late 40s. I find that tamsulosin just simply doesn’t work for me and it caused retrograde issues. Like you, I have been on a combination of tamsulosin and 5mg of cialis - and it still hasn’t solved the urination issues, but retrograde has mostly improved.
I have an appt at MayoJax on Tues for another Uroflow test - and I’m sure I will fail that again. I find that my BPH is worse in the mornings despite the medications, but that by mid-day my urine flow is better. I’m still getting up 2-3 times a night. With all the different surgical procedures, how did you decide on Aquablation? Is aquablation the same as Water Vapor Thermal Therapy? To complicate matters, I am a liver transplant patient, and I’m trying to get off of as much medication as possible, so I think it’s time to take action on the BPH. My brother had Holep , but his prostate was over 200g. I think mine is about 60g. I don’t want to end up with RE or other sexual side effects if at all possible. Would appreciate any advice you might have.
Replies to "Hi Phil. I am 64 and have had BPH since my late 40s. I find that..."
@gerryp - Great questions. Let me work on answering them.
My prostate wasn't gigantic but more like yours in size. My principal objective was to reduce my daily medicine requirements - plus the tamsulosin/Cialis cocktail wasn't producing the desired "no bph symptoms" effect. I also wanted to eliminate RE if at all possible
I have been a urology outpatient of Mayo (JAX) since 2015. I also have other medical connections with Mayo - all super-successful in terms of outcome. So I trust what I hear from their medical teams.
During a regular urological exam in the Fall of 2023, they described they had begun planning to bring aquablation to the clinic early in 2024 and that the procedure might be worth my consideration. I went home, did some on-line research, then raised my hand to say, "Put me on the list!"
In very short order they called, I completed an on-line consult with the urologist/surgeon, and that very day we decided to go forward.
How did I decide on aquablation? Mostly, I relied on my built-up trust in Mayo. After doing some research online I decided the extremely low risks of aquablation balanced against my desire to reduce pill intake while eliminating all bph symptoms (my multi-pill-a-day regime didn't eliminate all symptoms) - It was an easy decision and I'm pleased with the result. I guess there might be other procedures that could have produced the same result...
It was my prior tamsulosin/Cialis cocktail that produced an RE side effect. I believe RE is a side effect of tamsulosin rather than a side effect of bph. I'm now 3 1/2 months post aquablation and there have been no sexual side effects while my previous RE has abated and continues to increase in volume. Orgasmic intensity is unaffected.
I still get up a few times a night to urinate - but way less than before aquablation. Urine flow is satisfyingly strong, bladder emptying is complete, and the "need to pee" has significantly declined in intensity.
Of course, my exact experience may not be yours if you undergo aquablation.
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I am 60 and also have BPH issues (and prostate cancer that is Gleason 6, on active surveillance). My urologist did a cystoscopy to determine what was causing the blockage, and then set a treatment plan from that.
In my case, it was an enlarged median lobe. He recommended a partial TURP procedure to remove the median lobe rather than aquablation or HoLep of the whole prostate. He also does aquablation, but the reason he recommended partial TURP is because he felt that preserving as much of the prostate as possible now, and doing the least invasive treatment now, would better preserve cancer treatment options down the line if the cancer progressed. And would potentially reduce the risk of later complications like incontinence from the cancer treatment. He felt that more significant treatments like HoLep or Aquablation would definitely resolve the issue, but would make some prostate removal treatments later a bit more tricky. Doable, but tricky.
So, to get a second opinion I met with Mayo in Rochestor to discuss HoLep and they felt confident they could solve the BPH issue and weren't too concerned about the difficulties of treating cancer later. I then asked them whether they could come back and do HoLep after a partial TURP and they said no problem. So that was a plus. As a side note, I asked them if they could do a partial HoLep on just the median lobe and they could. A Mayo doctor in Jacksonville does this.
I then spoke with my urologist about it later. He said that yes that is possible, but didn't feel like that was necessary given the simpler approach of a partial TURP. Also, he mentioned that if he were to try and do a partial aquablation, it produces some rough edges and that he'd have to then go in and do some clean up with the TURP tool. In his mind, why do the partial HoLep when it's overkill and why do the aquablation when cleanup is needed anyway from the TURP tool. That's why he chose the TURP tool. I also got the impression from the Mayo doctor that he wasn't too excited about a partial HoLep procedure.
So, for me I liked the idea of potentially resolving the issue for several years (5+ hopefully, if not longer) with the least invasive treatment of just the median lobe. But to get to that decision, it all started with the cystoscopy.