Aquablation: Post-surgery expectations

Posted by Phil, Alumni Mentor @upstatephil, Jan 26 8:05am

After decades of pills to (partially) manage BPH, I am scheduled for aquablation at Mayo JAX in mid-Feb. Has anyone had that procedure done? What was post-surgery like? What were your experiences regarding regular vs. retrograde ejaculation?

My expectations are high. My general health is good+ (71 yo), my prostate is enlarged but not massive, my PSA's suggest no cancer concerns. The surgeon expects a low-risk procedure (no incisions I believe) and a quick recovery (unless something unexpected pops up). I appreciate it's impossible to predict surgical outcomes with certainty - I would like to hear of others' experiences to help set my expectations.

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@jojo99


Ten weeks after Aquabilation surgery it is worse than before the surgery. Except I can urinate with no problem compared to before when I had to go to emergency get a catheter for urination. But now I have the following problems. 77 year old male with a prostate 140 CC'. This is a note I sent to my doctor. Said he will answer questions on next weeks visit but it could take another 3 months to become normal. Almost 6 months, really! Anyone care to chime in with answers if you have had these problems 10 weeks or longer after Aquabilation surgery thanks.
One,
In chat rooms that I have read most men after 2 to 8 weeks, now are normal in the areas of no urgency of urination, once or twice a night urination and no burning at the end of urination. Yet I still have all those symptoms of urgency, incontinence, frequency, burning, is this normal? What is the average time you see that your patients become normal?
Assuming it's not a urinary tract infection what can be done?
Two,
I’m in my ninth week since surgery. If the urine culture test keeps showing no growth of bacteria. Then to cover all my bases to make sure that it's not an UTI, do you have any experience with DNA-based testing methods for UTI? Such as PCR or NGS. From my research it said they are more accurate. Or anything else you can suggest?
Three,
My wife and I started having sex 4 weeks after surgery approximately three to four times a week, In the approximately 14 times we had sex I had a good erection but only ejaculated fluid 3x very lightly few weeks in between each time. The other 11 orgasms I assume were reverse ejaculations, although I never see anything else in my urine afterward. But I still had good orgasms. Am I the unlucky 10% that will have a reverse ejaculation? Or if it will come back how long does it take?
Four.
My penis when erect now bends to the right since the
Aquabation. Before it was always straight out. I read in my research after prostate surgery, I could come down with a condition called Peyronie's disease. Will it stay like this or get worse and become painful. Can it be fixed if it becomes painful or worse?
Five,
I've only had four clots of various size weeks apart since the aquibation surgery, come out when urinating. The last one very small two days ago. Is this normal, shouldn't I have had a lot more? The reason I asked because when I had my Cystoscope, I had a couple of toilet bowels full of large clots.
Thank You.

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I am now about 5 or 5and a half months post aquablation.
As a 74 years old, I was not having a big problem with urination, but the doctor warned me that my prostate was huge and action was necessary.
I was miserable with the results until just very recently.
I had to wear depends, urination was too frequent, and urgency cropped up frequently.
I couldn't urinate standing, because the flow sometimes became a spray (messy ). So I sat. There was some burning prior to the flow getting started, which sometimes didn't get going real well.
Some nights I had to urinate 4 or 5 times.
In other words, procedure made me worse, not better.
The first time I reached out to my urologist, a few months ago, he told me to be patient, that things would settle down.
That became somewhat true, but only very recently. I have stopped with the depends, but I make sure to always be close to a toilet, or to be sure to empty my bladder before leaving the house. If careful, I can stand up to pee.
The amount of time I can wait between toilet visits varies from just under an hour to more than 2 hours. I make sure to not take chances, and urinate at even a small urge.
I any case, last time I saw the Urologist, he claims I had signs of a UTI, (some mucous noticeable in urine) so I am taking Cipro. Some relief, so I refilled and will try another dose.
I am definitely more comfortable without Depends, and the burning/discomfort has reduced somewhat. Without the depends I do get some seepage, which I usually don't notice until I feel a little dampness in under wear or pajamas.
Sex has been non existent. Surely the fact that my wife was diagnosed with stage zero breast cancer 3 months ago has not helped with intimacy. The most we manage in that part of life is to show affection, like gentle cuddling or hand holding.
To summarize, I was very unhappy with the whole thing until very recently when I noticed a flicker of light at the end of the runnel.
If I'm not measurably better in 3 months the doctor has threatened me with a cystoscopy. I had that procedure once years back and dread it. I cant understand why patients are not sedated when they do that.
Best of luck to you. Be a patient patient, and surely things will settle down, albeit a lot slower than you were told,

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@dm2473

I am now about 5 or 5and a half months post aquablation.
As a 74 years old, I was not having a big problem with urination, but the doctor warned me that my prostate was huge and action was necessary.
I was miserable with the results until just very recently.
I had to wear depends, urination was too frequent, and urgency cropped up frequently.
I couldn't urinate standing, because the flow sometimes became a spray (messy ). So I sat. There was some burning prior to the flow getting started, which sometimes didn't get going real well.
Some nights I had to urinate 4 or 5 times.
In other words, procedure made me worse, not better.
The first time I reached out to my urologist, a few months ago, he told me to be patient, that things would settle down.
That became somewhat true, but only very recently. I have stopped with the depends, but I make sure to always be close to a toilet, or to be sure to empty my bladder before leaving the house. If careful, I can stand up to pee.
The amount of time I can wait between toilet visits varies from just under an hour to more than 2 hours. I make sure to not take chances, and urinate at even a small urge.
I any case, last time I saw the Urologist, he claims I had signs of a UTI, (some mucous noticeable in urine) so I am taking Cipro. Some relief, so I refilled and will try another dose.
I am definitely more comfortable without Depends, and the burning/discomfort has reduced somewhat. Without the depends I do get some seepage, which I usually don't notice until I feel a little dampness in under wear or pajamas.
Sex has been non existent. Surely the fact that my wife was diagnosed with stage zero breast cancer 3 months ago has not helped with intimacy. The most we manage in that part of life is to show affection, like gentle cuddling or hand holding.
To summarize, I was very unhappy with the whole thing until very recently when I noticed a flicker of light at the end of the runnel.
If I'm not measurably better in 3 months the doctor has threatened me with a cystoscopy. I had that procedure once years back and dread it. I cant understand why patients are not sedated when they do that.
Best of luck to you. Be a patient patient, and surely things will settle down, albeit a lot slower than you were told,

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Thank you for your reply.
My bleeding slowely stopped after about 6 weeks. Now in my 10th week for the last few days off and on.
I'll bleed for a few urinations with or without clots.
Then go back to a light yellow urination, the first time since the surgery. Dr said it was normal? Have you experienced this?
I thought I was the only one going this long with problems after aquibation now in my 10th week. They advertise it and you read most men are fine after 5 weeks. Are we just the unlucky ones, or there are other guys out there who have suffered as long. Let's hope we get some more replies to see that we're not the only ones.

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I know a few men who had aquablation, and they are generally satisfied after a few months.
One fellow I know had to have the procedure repeated within a week or two, because the first effort left him unable to pee at all. But after the 2nd procedure, he recovered quickly.
I know several men who had TURP. One of them is not fully recovered over a year after. He urinates better than prior, but he can't control the direction, so he sits to urinate.
A lesson to be learned, don't rely on doctor google for a post surgery analysis.

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@uniform8

Thanks for your posting; I am 70 and had an aquablation procedure in Arlington VA Mid January 2024. I was one night in the hospital and then had a Foley Catheter for 4 days. I am now in the 6th week of recovery. I had blood in the urine for the first 4 weeks and urination burned toward the end of voiding. The hematuria is gone, but I still have pain (bladder spasms) that result in an urgent need to urinate. I also now have retrograde ejaculation which after reading the surgery report realize it was due to the area of the prostate, the only issue I have with RE is it is also painful again I assume due to spasms. In the literature I received I thought the expectation was that after 4 weeks all would be great... but I seem worse off than before I had the procedure. I assume that the spasms will eventually go away - does anyone have similar experiences?

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I wish mine was going as well. Also had aquablation surgery at Arlington Hospital 6 weeks ago. Frankly, I'm not sure that going through with surgery was a good idea. I'm in a much worse place than I was pre-surgery on practically every metric. I have intense pain when urinating. The need to urinate is more frequent and I'm also having problems with incontinence which is entirely new. I just feel ground down by this whole experience. I've had to cut back on my travel and sleep is intermittent.

Tell me it will get better...someday..??

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@jojo99

Thank you for your reply.
My bleeding slowely stopped after about 6 weeks. Now in my 10th week for the last few days off and on.
I'll bleed for a few urinations with or without clots.
Then go back to a light yellow urination, the first time since the surgery. Dr said it was normal? Have you experienced this?
I thought I was the only one going this long with problems after aquibation now in my 10th week. They advertise it and you read most men are fine after 5 weeks. Are we just the unlucky ones, or there are other guys out there who have suffered as long. Let's hope we get some more replies to see that we're not the only ones.

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Who was your doctor who did the Aquablation surgery?

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@hiker35

I wish mine was going as well. Also had aquablation surgery at Arlington Hospital 6 weeks ago. Frankly, I'm not sure that going through with surgery was a good idea. I'm in a much worse place than I was pre-surgery on practically every metric. I have intense pain when urinating. The need to urinate is more frequent and I'm also having problems with incontinence which is entirely new. I just feel ground down by this whole experience. I've had to cut back on my travel and sleep is intermittent.

Tell me it will get better...someday..??

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My experience was similar.
Surgery in May, for several months I was worse than before the surgery.
It took an unexpectedly long time to start to feel some improvement.
Now, 6+ months later, there is noticeable improvement.
But I haven't gotten to the point I was prior to surgery.
Currently trying to wean myself off of the Depends.
Pain on urination has subsided a lot, but still feel some discomfort.
Flow is ok, but inconsistently so.
Urgency comes and goes. Usually waking to urinate 2 times per night. After surgery I was getting up as many as 4 times a night. Prior to surgery I was getting up 1 time in the middle of the night.
So, all in all, my urination issue was better before surgery, regressed a lot following surgery, and is only recently, 6 months later, showing improvement.
Hoping to get to my pre surgery situation soon.

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I’m just about 4 months out from Aquablabation surgery. Almost everything is normal. Urgency problem is gone, thank goodness. The only thing that is slightly disappointing is the strength of my stream and the inability to completely empty (I’m probably at 80 to 90% empty after urinating). It’s definitely way better than before surgery but I’m not “peeing like a teenager again” as some guys have reported. Definitely acceptable but I feel like it could be even better. I haven’t talked with my doctor about it but I’m guessing that my age (73) and my weary and weaker old bladder may be holding me back some.
Anyway, still very glad I went through surgery. And for those still struggling with post surgical issues, hang in there. Many symptoms resolve themselves with time.

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I was asymptomatic until June. Acute Retention shut me down completely and I lived on a catheter for four months. Lots of bad things happened on the way to aquablation, which I knew I wanted versus Holep. Surgery was the end of September. My prostate was 110 grams and I had a trans perineal biopsy to ensure there was no cancer.

Surgery lasted about 75 minutes. I needed to stay in the surgical ward under quarantine, as the long term catheter use infected me with Seratia bacteria. I bled a lot and stayed an extra night in the hospital. Surgery on Friday, discharged on Sunday. I was supposed to have the drain catheter out on Monday...but I was still bleeding too heavily. The spasm from the drain catheter were the worst part. The catheter came out on Friday...a week after the procedure.

I drank 3 quarts of water every day. At around day 17 the bleeding completely stopped with no more clots being passed. I only had two or three days of passing clots. From the very first moment the catheter came out, I was peeing like a racehorse. For the first two weeks it was every ninety minutes...both day and night. By the start of the third week, I was back to 4-5 times during the day...once per night. Volume is much greater than I was passing before the procedure. I haven't peed like this in years...maybe decades.

Semen is being ejaculated forward and out. I do not think my penis is any shorter, which is good. I've never been the biggest tool in the shed. I am on a steady diet of pumpkin seeds, salmon, tomato sauce and green tea. I do not want to go through this again in ten years...but I highly recommend aquablation. Just be prepared to bleed for a while if you have a larger prostate.

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@icorus1959

I was asymptomatic until June. Acute Retention shut me down completely and I lived on a catheter for four months. Lots of bad things happened on the way to aquablation, which I knew I wanted versus Holep. Surgery was the end of September. My prostate was 110 grams and I had a trans perineal biopsy to ensure there was no cancer.

Surgery lasted about 75 minutes. I needed to stay in the surgical ward under quarantine, as the long term catheter use infected me with Seratia bacteria. I bled a lot and stayed an extra night in the hospital. Surgery on Friday, discharged on Sunday. I was supposed to have the drain catheter out on Monday...but I was still bleeding too heavily. The spasm from the drain catheter were the worst part. The catheter came out on Friday...a week after the procedure.

I drank 3 quarts of water every day. At around day 17 the bleeding completely stopped with no more clots being passed. I only had two or three days of passing clots. From the very first moment the catheter came out, I was peeing like a racehorse. For the first two weeks it was every ninety minutes...both day and night. By the start of the third week, I was back to 4-5 times during the day...once per night. Volume is much greater than I was passing before the procedure. I haven't peed like this in years...maybe decades.

Semen is being ejaculated forward and out. I do not think my penis is any shorter, which is good. I've never been the biggest tool in the shed. I am on a steady diet of pumpkin seeds, salmon, tomato sauce and green tea. I do not want to go through this again in ten years...but I highly recommend aquablation. Just be prepared to bleed for a while if you have a larger prostate.

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Thanks for the update! Where did you have your aquablation and who did it?

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@av8r6

Thanks for the update! Where did you have your aquablation and who did it?

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I had my operation at Middlesex hospital in Middletown, Connecticut. Doctor Ed Myer. He operates two days per month and does 5 aquablations in a day. He is the only surgeon in the state of Connecticut who does aquablation...and it takes a while until you get an appointment...but highly recommended. The nurses and care I received at Middlesex was outstanding!

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