1. < Men's Health

Aquablation: Post-surgery expectations

Posted by Phil, Alumni Mentor @upstatephil, Jan 26, 2024

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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jleeg | @jleeg | 2 days ago

Have you ever used a Tadalafil or Tamsulosin prescription for BPH ( enlarged Prostate)? If so what were the results? What was your experience with the drug? Any side effects? I have not had any positive relief or improvement using either for several months, just bad side effects: headaches and dizziness and brain fog .

Have you ever tried using over the counter supplements such as Lycopene, B-Sitosterol, zinc and others separately or in combination. If so, what was the dosage and results.
Thanks for sharing.

REPLY
rstark | @rstark | 2 days ago
In reply to @jleeg "So, what is your experience? Do you feel comfortable talking about it? Was there an operation...." + (show)
@jleeg

So, what is your experience? Do you feel comfortable talking about it?
Was there an operation. If so, are there any side effects? Pain or discomfort?
Did the procedure provide any reduction in frequence of urination?
Are you happy/okay with the results?

Jump to this post

Yes. I had an aquablation in February 2025. So far, everything seems to be going very well. There was initial discomfort after the procedure. I had a catheter for 3 days and there was some mild discomfort peeing for about 3 weeks. I have reduced frequency both day and night. I feel I'm able to empty my bladder each time; the median lobe is gone. I'm very happy with the results.

REPLY
brucekn | @brucekn | 1 day ago

I have had urologists attempt to control my urine retention now for years, with 2X TURP procedures (the second one caused partial ED), and some UroLift components inserted into my prostate. The most recent procedure was an Aquablation in last December (2024). The procedure seemed to go well (I was asleep, of course), and I stayed the night in the hospital while nurses came in every hour or so to change water bags that were feeding distilled water up my penis in a tube, and then draining it (along with a lot of bloody discharge). My only issue was that I couldn’t urinate on my own at the time of discharge from the hospital, so was given a Foley catheter- which several days later got blocked and resulted in a trip to the ER to remove it.

I noted after I had been home for a week that when I walked, I had urine incontinence. Only when I walked, I believe it’s called “Stress Incontinence”. My urologist had me do Kegel exercises, strengthening my pelvic floor, and after a few weeks the stress incontinence passed- I can now walk without any embarrassment of having a wet soiled circle on my trousers in a conspicuous location. The blood in the urine has gone, I have a good urine stream, and my urologist measured 7ml of urine retention (down from significantly more prior to the procedure), and he is very happy. My only issue now is a very low grade urine incontinence that appears to occur when I sit, and/or when my bladder is full. There’s not enough urine to cause a soiled area on my trousers, more like what I would expect from sweat- only very mild dampness in my underpants, but invisible- I only know it occurs by the dampness. It’s now been 4 months out, so hoping to get past this by containing my Kegel exercises.

REPLY
stein5488 | @stein5488 | 21 hours ago

Follow up to original post. I'm now almost a month post op (March 26th surgery) and still quite happy with the results. My surgeon told me my prostate was at 120mil in size which evidently is huge. I'm assuming because of that and the amount of tissue that was removed I have experienced continual bleeding. Heavy for three weeks but the last couple of days, just a hint of red. If I'm following doctors' orders and drinking lots of water, I barely notice a hint of bleeding. I am only getting up once during the night to urinate and it's quite easy to start the flow and I feel like I completely empty my bladder. The sudden urges to pee are subsiding as is the burning sensation. Neither of those conditions were a big problem even originally. Not sure on the RE yet as I've only had one attempt at that and only a small amount of semen was discharged. Hoping that situation improves but if it doesn't, I will still consider the surgery a huge success. My surgeon told me I would be peeing like a 20-year-old after the surgery. That was 48 years ago, and I can't quite remember how it was back then, ha, but I will say I think I can rival my 40-year-old self.

REPLY
bryn1203 | @bryn1203 | 12 hours ago

I write this blog following my recent experience of aquablation surgery 25 days ago.
I welcome advice from anyone with similar experience I outline at the end of this report but will give my background first.

I was diagnosed with prostate cancer 8 years ago with a low gleason score and have been on the ‘watch and wait’ programme with PSA blood tests being monitored every 3 months. They have ranged from 7 to 11 over this period and my consultant remains unconcerned at this stage.

I am 66 years of age ‘fit’ and healthy at 6ft 2 inches and 12 stone 12 lbs (81kg). I’ve never smoked and rarely drink any alcohol.

4 years ago I went into ER for acute urinary retention and then 3 months ago acute urinary retention in ER again resulting ing a catheter for the past 3 months. MRI showed my prostate had double ti 2 years to 137 cc. I had been taking Tamsulosin for 8 years and for 4 month Finasteride.

On 29 March 2025 I had my aquablation op and was told all went well considering the size of the prostate !

I stayed 2 nights in hosp not the one suggested and was released with a catheter returning to hosp on day 4 for its removal and several flow tests. Euphoria kicked in as pee’d like the proverbial horse. I went home catheter free to my new life… it lasted 24 hours. Then the nightmare began. I was admitted to ER with blood clots and acute urinary retention again admitted back onto the hospital ward and was told this is normal … so normal I was released the following day. Only for the same to happen again 24 hrs later and a re admission onto hospital ward with re cathetirisation and morphine. I was released again on for 48 hours later for the same clotting to happen again with urinary retention. SO my assumption is ‘size does matter’ as my prostate being twice the normal enlarged prostate was going to have double the ‘damage’ inflicted.

I was released again for 10 days and went back to hosp to have catheter removed. Undertook 3 flow tests and was delighted with the result only the nurses weren’t .I was leaving over 150 ml after voiding. I was sent home with a re admission to hosp the next day where my flow tests improved , slightly. I was sent home with self catheterisation material which I haven't used. I’ve had 5 days at home and have been ok. Although I’m up every 2 hours between 11pm and 7am peeing and checking for clots. Ive now developed my first UTInfection and am on antibiotics. Things seemed to be getting better although I have a lot of perineal pain when peeing. I believe this is normal. However tonight at 9pm after a good flow rate all day I go to bathroom and pee over 100ml of blood. After several hundred mls of water later I’m still bleeding and have passed a small clot my question is. Is this normal as being intermittent and now a sudden change 25 days after surgery. I will keep you posted on positive progress but the smiley brochures and You Tube re assurances and testimonies of ‘ road to recovery stories after a week or so have not been my experience at all.

REPLY
bryn1203 | @bryn1203 | 12 hours ago
In reply to @peehelp23 "Hello. 66 year old in good shape, work out etc. Had enlarged prostate for about 15..." + (show)
@peehelp23

Hello. 66 year old in good shape, work out etc. Had enlarged prostate for about 15 years, 2 biopsies back at beginning due to high PSA score and both negative. (NOTE: Follow ups of PSA's and Free PSA's along with 4K indicate no cancer). Watchful waiting over the years with frequency and stream problems worsening slowly. In December of 2023, got to point that something needed to be done. Prostate size 110 cc. My urologist suggested simple prostatectomy and it seemed extreme. I asked him about aquablation and he said few do it, but seems to be a good option. Went to Mt. Sinai in Manhattan to a Dr. Kaplan, who is said to be one of the best at this procedure. My urologist advised that Mt. Sinai has great uro staff.
Scheduled aquablation for 2/28/24. On 1/8/24, had a urodynamic flow test by a nurse at Mt. Sinai. Seemed to be tough to get to done and there was bleeding. This is to check if bladder emptying. Within 36 hours I was in emergency room with complete blockage and a catheter had to be put in. I had never had a catheter before. Advised Dr. Kaplan and we spoke by phone and a scheduled rectal ultrasound was for 1/22/24. Went to my original uro approximately 1/17 to take out catheter. Within hours back to ER for another catheter.
After the rectal ultrasound on 1/22/24, Dr. Kaplan advised that there was a medial lobe extension into the bladder that would be addressed during the aquablation. I asked (begged) to fit me in sooner as he advised that I would need to keep the catheter in until then. No avail.
Pre-op tesgting for surgery clearance indicated uti (light staph infection only) and took antibiotics.) Aquablation on 2/28/24 that took about 1 hr. and 15 minutes. Apparently went well. 1 night in hospital and home with catheter, which was removed three days later and stream was good, no blood (other than in the hospital where clots and blood were cleaned out with heavy irrigation.)
On 4/8/24, had pain in the lower abdomen right side and went to Urgent Care and CT scan indicated no problems with bladder or prostate area or any where for that matter. Staph infection diagnosed and treated.
Moved along and saw Dr. Kaplan in May '24 and seemed to be going well, good flow, getting up once maybe twice a night, but somewhat still limiting fluid intake. Fast forward to Dec. '24 and starting to have more problems with urgency and frequency, feel like I have to pee throughout the day more times than not.
Seen Kaplan on 12/16/24 and he did a rectal ultrasound indicating that the aquablation had reduced the size of the prosate to 80 cc and he would have liked it to be smaller (40% reduction). I advised him of the urgency and frequency issues and he quoted that " you wouldn't want to do another aquablation". Very little questioning allowed with this Dr. So here I am in March '25 and I am now going through bouts of having to pee many times throughout the day, even though really have limited my fluid intake, some pain in lower left abdomen area and in the perineum (area between anus and scrotum). From some research, I think I need to actually take in more water and it may help. I have appointment with my regular uro on 3/25 as he is on vacation. I still work and have to drive moderate distances when on road. This doesn't help. Not sure where to go from here. Hope this helps those in similar predicament and appreciate hlep from anyone who has successfully gotten through something lke this. Thanks, Joe

Jump to this post

I found your story very helpful. I've just posted mine . I will keep you posted with any positivity I can muster good luck.... I write this blog following my recent experience of aquablation surgery 25 days ago.
I welcome advice from anyone with similar experience I outline at the end of this report but will give my background first.

I was diagnosed with prostate cancer 8 years ago with a low gleason score and have been on the ‘watch and wait’ programme with PSA blood tests being monitored every 3 months. They have ranged from 7 to 11 over this period and my consultant remains unconcerned at this stage.

I am 66 years of age ‘fit’ and healthy at 6ft 2 inches and 12 stone 12 lbs (81kg). I’ve never smoked and rarely drink any alcohol.

4 years ago I went into ER for acute urinary retention and then 3 months ago acute urinary retention in ER again resulting ing a catheter for the past 3 months. MRI showed my prostate had double ti 2 years to 137 cc. I had been taking Tamsulosin for 8 years and for 4 month Finasteride.

On 29 March 2025 I had my aquablation op and was told all went well considering the size of the prostate !

I stayed 2 nights in hosp not the one suggested and was released with a catheter returning to hosp on day 4 for its removal and several flow tests. Euphoria kicked in as pee’d like the proverbial horse. I went home catheter free to my new life… it lasted 24 hours. Then the nightmare began. I was admitted to ER with blood clots and acute urinary retention again admitted back onto the hospital ward and was told this is normal … so normal I was released the following day. Only for the same to happen again 24 hrs later and a re admission onto hospital ward with re cathetirisation and morphine. I was released again on for 48 hours later for the same clotting to happen again with urinary retention. SO my assumption is ‘size does matter’ as my prostate being twice the normal enlarged prostate was going to have double the ‘damage’ inflicted.

I was released again for 10 days and went back to hosp to have catheter removed. Undertook 3 flow tests and was delighted with the result only the nurses weren’t .I was leaving over 150 ml after voiding. I was sent home with a re admission to hosp the next day where my flow tests improved , slightly. I was sent home with self catheterisation material which I haven't used. I’ve had 5 days at home and have been ok. Although I’m up every 2 hours between 11pm and 7am peeing and checking for clots. Ive now developed my first UTInfection and am on antibiotics. Things seemed to be getting better although I have a lot of perineal pain when peeing. I believe this is normal. However tonight at 9pm after a good flow rate all day I go to bathroom and pee over 100ml of blood. After several hundred mls of water later I’m still bleeding and have passed a small clot my question is. Is this normal as being intermittent and now a sudden change 25 days after surgery. I will keep you posted on positive progress but the smiley brochures and You Tube re assurances and testimonies of ‘ road to recovery stories after a week or so have not been my experience at all.

REPLY
bryn1203 | @bryn1203 | 11 hours ago
In reply to @geoffpuma999 "Like @snoopy48 I'm based in UK and 11 days ago underwent Aquablation surgery in the Candover..." + (show)
@geoffpuma999

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.

Jump to this post

Geoff good to read your summary so far... I'm in UK too here's my situation so far. The bleeding and clots have returned excessively tonight I will keep you posted with any positivity I have ......I write this blog following my recent experience of aquablation surgery 25 days ago.
I welcome advice from anyone with similar experience I outline at the end of this report but will give my background first.

I was diagnosed with prostate cancer 8 years ago with a low gleason score and have been on the ‘watch and wait’ programme with PSA blood tests being monitored every 3 months. They have ranged from 7 to 11 over this period and my consultant remains unconcerned at this stage.

I am 66 years of age ‘fit’ and healthy at 6ft 2 inches and 12 stone 12 lbs (81kg). I’ve never smoked and rarely drink any alcohol.

4 years ago I went into ER for acute urinary retention and then 3 months ago acute urinary retention in ER again resulting ing a catheter for the past 3 months. MRI showed my prostate had double ti 2 years to 137 cc. I had been taking Tamsulosin for 8 years and for 4 month Finasteride.

On 29 March 2025 I had my aquablation op and was told all went well considering the size of the prostate !

I stayed 2 nights in hosp not the one suggested and was released with a catheter returning to hosp on day 4 for its removal and several flow tests. Euphoria kicked in as pee’d like the proverbial horse. I went home catheter free to my new life… it lasted 24 hours. Then the nightmare began. I was admitted to ER with blood clots and acute urinary retention again admitted back onto the hospital ward and was told this is normal … so normal I was released the following day. Only for the same to happen again 24 hrs later and a re admission onto hospital ward with re cathetirisation and morphine. I was released again on for 48 hours later for the same clotting to happen again with urinary retention. SO my assumption is ‘size does matter’ as my prostate being twice the normal enlarged prostate was going to have double the ‘damage’ inflicted.

I was released again for 10 days and went back to hosp to have catheter removed. Undertook 3 flow tests and was delighted with the result only the nurses weren’t .I was leaving over 150 ml after voiding. I was sent home with a re admission to hosp the next day where my flow tests improved , slightly. I was sent home with self catheterisation material which I haven't used. I’ve had 5 days at home and have been ok. Although I’m up every 2 hours between 11pm and 7am peeing and checking for clots. Ive now developed my first UTInfection and am on antibiotics. Things seemed to be getting better although I have a lot of perineal pain when peeing. I believe this is normal. However tonight at 9pm after a good flow rate all day I go to bathroom and pee over 100ml of blood. After several hundred mls of water later I’m still bleeding and have passed a small clot my question is. Is this normal as being intermittent and now a sudden change 25 days after surgery. I will keep you posted on positive progress but the smiley brochures and You Tube re assurances and testimonies of ‘ road to recovery stories after a week or so have not been my experience at all.

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