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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Profile picture for johnlondon @johnlondon

Aged 65, had aquablation (in London) 14 weeks ago, just had to have TURP to fix complication due to a band of tissue blocking urethra.

So mine is a story of what can go wrong. Recover from aquablation was slow (extra 10 days on catheter as went into retention) and from around 4/5 weeks it was obvious that I was way off the recovery curve and there was a problem. Things were going backwards. Painful to pee, weak flow. Surgeon kept kicking ball down road with talk of 'time to heal', 'Let's give it a few more weeks', 'I'll give you some different antibiotics'.

At round 11 weeks did another flow and PVR which showed the Qmax the same as before surgery and residual urine also at pre-surgery levels. The flow rate pattern looked obstructive to me (or rather Google), but surgeon didn't mention his view. He just said it was below average.

More surgeon chasing and updates - Flexible cystoscopy organised and above sphincter in prostate apex, tissue had grown and blocked the channel like a curtain with two smallish holes in it. I'd say it was an 80% blockage. TURP procedure required to remove tissue. That was 2 days ago. I'm back home.

Despite being only 2 days post op, feels better already. The point here is that the surgeon's confidence (hope?) in a complication free procedure meant that I had to spend 3 months in discomfort while he issued scrips for antibiotics that did nothing and played 'wait and see'. My symptoms 6 weeks after surgery were probably enough to merit further investigation without me having to push.

My own (not a doctor) theory is that heavy bruising of the bladder neck (mentioned by surgeon) cause a swelling that caused retention 24 hours after original catheter removed. They couldn't get a normal sized catheter through the swollen tissue and had to scale down to a 3mm foley. Even that was hard to get in. This was left in place for 10 days (because of national holidays). I suspect this acted as a scaffold for the tissue to grow across the urethra. I think one hole was the original channel and the second hole was the catheter pushing a channel through sheets of newly forming tissue - possibly pushing a strand across to start the bridge. Trapped by the catheter and not moved by urine flow, the tissue grew.

The catheter came out and from that point the flow and discomfort just got worse as time passed and the tissue filled in the gap.

Unlike TURP which cauterises the urethral wall, aquablation leaves a rough, raw, living surface with a lot of 'candy floss' debris and ribbons of live tissue. Many surgeons use a TURP tool to clear out this debris surface and cauterise bleeds. I wonder if this difference in the nature of the surface left after surgery makes aquablation a bit more prone to these adhesions across the urethra?

Anyhow, two surgeries, lot of expense and frustration, plus a lost year of discomfort. Fingers crossed that this time, we are where we need to be. My point is that if your recovery is way off what is expected and you have clear symptoms, you may have to decide at what point you start to push for investigation to save yourself a very long wait for the surgeon to come to the conclusion that things have not gone as hoped.

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Very sorry you had complications - I know first hand how awful a catheter is. Aqua does not remove all the Adenoma of the prostate, maybe 50% or so. It depends on how it's programmed and how many passes it takes. More importantly, the instrument does not rotate 360 degrees but around 225 degrees leaving 135 degrees of tissue untouched. This can grow back or possibly be the cause of the curtain of tissue. As mentioned the surface is very rough and bleeds requiring another instrument for cautery. I loved the idea of better chances of normal ejaculation with Aqua but chose HoLEP to avoid some of the problems and a better chance of "once and done". Hope you are feeling better soon

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63 active male with a rather large prostate of 130g. Brother had aquablation and results were great for him. On Tamsulosin. Was getting up 2-3 times a night, very weak stream, always felt like I could never empty my bladder.
Surgery was Jul 14 in Middletown CT. The local Dr here was one of the first to bring this surgery to CT. He was great and experienced One overnight stay in hospital, 3 more days with the Foley catheter. Zero pain throughout the entire process. The thing I hated was the catheter- it wasn’t painful, just uncomfortable. In general, the more fluids I drank, the clearer the urine became. 5 weeks out and in general clear urine. A few incidents where I had some blood and a clot come out, even as recently as 4 weeks post surgery.
Post op appt today and dr said this is normal and if occasional blood, not to worry, drink more water and rest. Obviously if a lot of blood to call him.
My other issue I told him about was leaking. I have been using a female panty shield to catch the leaks. He told me to try pressing the prostate after urination to help with the leaks. I have to say, this seems to work and is so simple that I figured I should post in case someone had the same issue. Sex is the same as before surgery. Off Tamsulosin as well. I get up once per night and seem to fully empty. Stream is strong (told my wife I might be able to chip the porcelain off the toilet, lol).

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Profile picture for aapisani5 @aapisani5

The answer is both. Large tissue required an instrument done real time without any type of pain killer; unnerving to say the least. I also pass smaller bits when urinating. It's not continually but very much episodic. A recent MRI shows prostate calcification so believe that's what I am experiencing.
The remaining issue is that following a strenuous run there is substantial blood in the urine. I was put on Finasteride for 6 weeks and have a scheduled meeting with the surgeon the end of this month where they will do a scope. Other than the blood in the urine the aquablation did what it was intended to do; better flow, less awakening at night, less sense of urgency, etc.

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Further update. Visited aqua surgeon yesterday 8/21 to discuss and scoped to determine why I have significant bleeding after running and also episodic discharge of material when urinating. Prior to visit I had a CT scan of the area. The results of the scan showed calcification of prostate. The scope showed a "garden of stones" which seems to be the culprit in terms of bleeding and discharge following a run. These stones are a result of the healing and is the first time my surgeon has encountered this after aqua. So what to do; three options presented; 1. Do nothing and deal with bleeding and discharge of material haphazardly; 2. Laser the stones which may require a catheter for a short period (the worst part for me); 3. laser the stones and the prostate which should provide more of a guarantee to stop the bleeding. Option 3 will require a longer recovery time. I have a decision to make. Has anyone else experienced this calcification/stones issue?

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Profile picture for bsol1986 @bsol1986

63 active male with a rather large prostate of 130g. Brother had aquablation and results were great for him. On Tamsulosin. Was getting up 2-3 times a night, very weak stream, always felt like I could never empty my bladder.
Surgery was Jul 14 in Middletown CT. The local Dr here was one of the first to bring this surgery to CT. He was great and experienced One overnight stay in hospital, 3 more days with the Foley catheter. Zero pain throughout the entire process. The thing I hated was the catheter- it wasn’t painful, just uncomfortable. In general, the more fluids I drank, the clearer the urine became. 5 weeks out and in general clear urine. A few incidents where I had some blood and a clot come out, even as recently as 4 weeks post surgery.
Post op appt today and dr said this is normal and if occasional blood, not to worry, drink more water and rest. Obviously if a lot of blood to call him.
My other issue I told him about was leaking. I have been using a female panty shield to catch the leaks. He told me to try pressing the prostate after urination to help with the leaks. I have to say, this seems to work and is so simple that I figured I should post in case someone had the same issue. Sex is the same as before surgery. Off Tamsulosin as well. I get up once per night and seem to fully empty. Stream is strong (told my wife I might be able to chip the porcelain off the toilet, lol).

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Dr. Myer is outstanding. I also had a lot of bleeding. Lived on a catheter for four months before the procedure. Large prostate that was completely asymptomatic...until I couldn't pee at all. I stayed an extra day at Middlesex. I'm a year out and still peeing like a racehorse.

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I am about 10 days post op. I went home with a catheter after staying in the hospital over night and it was removed 6 days later. My flow after catheter removal and for the next 12 hours was astounding, but then quickly went back to about where it was before the procedure, maybe even worse, and has stayed there for the most part. I feel lots of pressure as if it is mainly the urethra blocking flow, and I get occasional bloody urine at the very beginning but then mostly clear. The urologist told me multiple times that things would get worse before they get better, but it is discouraging to see the reduction. I know I am early in the recovery process, but I hope to start seeing improvement soon.

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After my experience with urolift then going to a major ranked hospital (KUMC) and my experience (6 weeks of misery) with Aquablation recovery and then only 7 months of good result. Then like flipping a switch, back to same as prior to surgery and on flomax. I can live with flowmax, but that 7 months was really nice!

Then I really don't get the answers that explain what happen after 7 months, I posted that in other threads.

Thinking if I ever try another surgery, I may do the old gold standard TURP? They have mention a more aggressive aquablation on really push hard for HoLep, but from what I read most, I am not impressed with HoLep.

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Just out of curiosity what is it about HoLEP you are not impressed with?
Thanks

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I just don't see enough people saying that it was really great and seems too many having leakage issues. Also, I have a friend that had it done and leakage issues still and it been a month. Would like to see 80 percent of post saying how great it worked.
But then I would bet those that all went well and things were great don't get on here and post.
Then I was told how great Urolift was- wrong. Then by a different doctor and facility how great Aquablation was- only lasted 7 months and recovery was not what they said. In fact I think a resident did the surgery??

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The good news is that over the last couple of days things have definitely improved for me, and while flow is not as good as it was immediately following catheter removal [9 oz in 15 sec] it is definitely better now [8 oz in 16 sec] than it was before the procedure. Still some occasional pink right at the start but then mostly clear. I can tell the urethra is still healing as there is pain along the length when sitting down or bending forward to get up, and still some occasional burning and mild pain when urinating. No need for any pain relievers since the catheter removal. I have been walking every day since about day 4 with no observed adverse affect. I am encouraged by this progress.

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Profile picture for bds508 @bds508

The good news is that over the last couple of days things have definitely improved for me, and while flow is not as good as it was immediately following catheter removal [9 oz in 15 sec] it is definitely better now [8 oz in 16 sec] than it was before the procedure. Still some occasional pink right at the start but then mostly clear. I can tell the urethra is still healing as there is pain along the length when sitting down or bending forward to get up, and still some occasional burning and mild pain when urinating. No need for any pain relievers since the catheter removal. I have been walking every day since about day 4 with no observed adverse affect. I am encouraged by this progress.

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That’s great to hear. Have you seen any clots come out in the last few days?. That could be the reason for the increase.

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