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 stevedc1 @stevedc1

I will have Aquablation near the end of January. Like most folks, I am “hoping” that, after the catheter is removed (5 days later), that I will be satisfied with the results. …long term. Am i being too optimistic ?

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@stevedc1 I think it depends a little on how much you delayed treatment and how much damage you may have done to your bladder as a result, but in general you should expect an immediate improvement in your urination and how much you have to get up at night. The biggest variance among us appears to be retention, frequency and retrograde ejaculation post procedure. The recovery for most is pretty rapid and very little pain. The catheter seems to be the biggest annoyance for most. My urologist offered PAE followed almost immediately by the aquablation so i only had the catheter for 24 hours, but i can understand the irritation. You have good reason to be very positive, even those who have had poorer results are generally better off. There are some, very few, with bad results but I think that is often a result of delaying treatment or age. My own recovery over the last 4 months has not been perfect, but I'm still tremendously better off and I feel lucky that this technology is now available compared to other procedures.

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Profile picture for stevedc1 @stevedc1

I will have Aquablation near the end of January. Like most folks, I am “hoping” that, after the catheter is removed (5 days later), that I will be satisfied with the results. …long term. Am i being too optimistic ?

Jump to this post

@stevedc1 From my experience I would say Aquablation is very successful. Five months after the procedure I have good control over my bladder and urine. I have had no issues with ejaculation. But my bladder control results were not immediate. They seemed to improve with time, so stay optimistic. I still have to get up one or two times some nights to pee, but it comes easier. I do not have to strain, so I am able to get back to sleep. On occasion I still have to rush to a toilet, but is much rarer than pre-procedure and something I can live with. Behavioral changes have also helped. I avoid carbonated beverages, including sparkling water, and I try to avoid liquids about 4 hours before bedtime. I do Kegel exercises for the pelvic floor, but they should not be started until a few months after the procedure. Good luck.

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Profile picture for stevedc1 @stevedc1

I will have Aquablation near the end of January. Like most folks, I am “hoping” that, after the catheter is removed (5 days later), that I will be satisfied with the results. …long term. Am i being too optimistic ?

Jump to this post

@stevedc1 I had the catheter in for 6 days and its been out for 11 days now. My prostate was quite large at 140cc, which apparently affects how long recovery will be. Smaller gland procedures heal more quickly. Since the first day the catheter was removed, urination came very easily with a good stream. Burning was fairly substantial and I still have it, but each day is getting better. Same with urgency and frequency. Each day is getting better and I'm very optimistic that a few weeks from now symptoms will hopefully be 100% resolved. Good luck!

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Profile picture for joez26 @joez26

@stevedc1 good luck! I’m happy with my results as far as urinating. Compared to what I went from to where I am is night and day. My only issue is that I am unable to ejaculate. I thinks it’s referred to retro grade. But not certain. Hoping that changes in the future.

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@joez26 I had a weak and even non-ejaculation issue before and after aquablation. Before the procedure, I place the blame on tamsulosin, which relaxes all muscles including the sphincter muscles essential for ejaculation. Even my sneezes were weak. Seems to me that medication takes away almost all of life's pleasures.

Post-aquablation, ejaculation started weakly then gradually got better. Aquablation can affect the sphincter muscle surrounding the neck of the bladder. Practice makes perfect or at least a noticeable improvement (pardon the humor).

Nonetheless it's reasonable to expect an improvement. Best of luck.

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Profile picture for vtredwolf @vtredwolf

@luferfish for what it's worth my doctors practice was in Northern Virginia at Potomac Urology, Dr Lim, but I don't know that my recovery is perfect either. At times encouraging and at other times not, but i don't blame the surgeon. The damage one has done to their bladder while delaying treatment plays a big role I think. As my doctor explained your bladder has been blocked by your prostate obstruction and depending on how damaged it was your urgency and frequency will now be impacted. Even at 64 I wish I had the surgery many years earlier in hindsight, but I had a poor Utologist who never even did a cystoscopy and when I brought up surgeries said I didn't need it. He was wrong, but I didn't find that out until he retired and I sought out a new Urologist practice who promptly informed me otherwise. The way I see it now I've traded not being able to go for a little more frequency, but I was eventually going to need surgery so putting it off only hurt me. I think that's my one bit of advice to people with BPH, don't delay surgery too long, it's only going to get worse and your success post surgery will be impacted. Don't get me wrong, my surgery was pretty painless, recovery quick, I get up only once a night most nights instead of 3 or 4, improved flow, no sexual side effects other than some occasional RE and when I want to go i just go, but if I drink something I'm probably going to need to find a bathroom in a couple of hours.

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@vtredwolf
Good day. I just saw your kind response. Sorry not thanking you earlier. My last situation is: I found out that my last urologist took only 33 cc out of 187 cc prostate. Which is only % 17.8 of the whole prostate. I think he fell into sleep with his Robot during the surgery. He told me he wants to do a TURP. I cannot believe it. I made an appointment with Jacksonville Mayo Clinique I will see what happens. Have a pleasant day.

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