Aquablation: Post-surgery expectations

@connect4321 thank you for the information and video. I have had Urolift by another incapable person too. I was better before 3 urologist and 2 surgeries. I am hoping I finally will have a help in Jacksonville Mayo Clinic.

Here's my post op instructions as it seems like many of you didn't get them.
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You may be sent home from the hospital with a prescription for an antibiotic but not necessarily so. If you are given a prescription for medication, this is to be taken before Foley catheter removal. If you took routine medications from other physicians preoperatively, you should resume these upon your return home. Before restarting the following medications such as Coumadin, Persantine, Plavix, and any aspirin or aspirin-containing products, we suggest that you discuss with your urologist. Discuss questions regarding routine medications with your family physician.

ACTIVITY:
Frequent short walks are helpful in your recuperation. Heavy lifting (more than 10-15lbs.) should be avoided for 2-3 weeks from the date of surgery. Do not delay urination when you have the strong urge to do so during the first few weeks following surgery.

CONSTIPATION:
Straining for bowel movements may result in an unusual amount of bleeding from the operative area, and this should be avoided. If you become constipated, use mild laxatives such as 1-2 tablespoons of Milk of Magnesia, Cascara or Dulcolax suppositories as needed. Stool softeners such as D.D.S, Dialose, Dialose-Plus or Metamucil may be useful. Other natural foods such as prune, dried figs, or bran and the like may also be helpful.

BLEEDING:
Many patients will notice some blood in the urine up to 2-4 weeks following all forms of prostate surgery. This may occur at the beginning or at the end of the urinary stream and occasionally throughout the entire specimen. If your urine becomes bright red rather than clear, yellow, or light pink, you are probably being too active and should probably go on a modified bed rest program for a day or two until the urine returns to more normal color. It is not unusual to see some bright red blood in the urine 10-14 days after prostate surgery. Should you pass an occasional blood clot, this is not too important. However, if you pass many clots or have difficulty voiding because of clot-obstruction to the urinary channel, then contact your urologist. If your bladder becomes distended and uncomfortable because of an obstruction, go to the Emergency Room of El Camino Hospital if you cannot reach your doctor or the on-call within a brief period of time.

SEXUAL INTERCOURSE:
Avoid sexual intercourse at least the first four weeks from the date of surgery. The timing of resumption of intercourse should be discussed with your surgeon before it is attempted. Often there is some bleeding associated with climax, but usually this is insignificant. Remember that little or no semen may pass when you climax, and this is expected after this type of prostatic surgery.

PAIN AND FREQUENT URINATION:
Mild discomfort upon urination or when you sit or put pressure on the perineum is common and unimportant. It is unlikely that you will have any severe pain, but if you do, contact our office. You may notice increased urgency to void or voiding more frequently than usual during the first few weeks following prostate surgery. This occurs while prostate capsule is healing. Both pain and frequency subside as the area of surgery heals and returns to normal. You may use Tylenol or pyridium as needed for discomfort. Remember to avoid aspirin and aspirin-containing products during this period of time.

FOOD AND DRINK:
There is no particular restrictions on the types of food and drink that you may use following surgery. We do not, though, that some patients notice more frequent urination after drinking coffee, tea, alcoholic beverages or consuming spicy foods. If this is a problem, then those foods and fluids should be avoided for the time being. You need not drink excessive amounts of fluid, for this will only make you void more urgently and more frequently. The exception would be times when the urine is bright red, in which case increasing fluid intake will help wash out and clear the urine more quickly.
QUESTIONS:
If you have any particular questions which you would like to discuss with your doctor, jot these down so that when we are able to make sure your questions are discussed with your surgeon.

@joseflesh thanks for the update. Not everybody seems to be happy with the aquablation procedure. Where did you have the procedure done? And by whom pls. Just to understand. Were you fixed in a scanner or did thy use an ultrasound device in the rectum?

Thought I'd update everyone about my doctor's appointment today, which I requested due to blood in the urine (hematuria) about 3 x each year - one day duration per occurrence - since my 2021 aquablation.

He had no explanation for it or offered no possible causes which to me suggests his limited access to post-op patient experiences. Or maybe my hematuria is actually rare.

To address the issue, he scheduled a cystoscopy in February. As to why not an MRI w/c he recommended 2 years ago, he said an MRI won't reveal polyps inside the prostate gland which a cystoscopy can. So, I'll know for sure in Feb if there's something serious like cancer going on.

I told him about the video "connect4321" posted, particularly the discovery of urolift implanted pins during the aquablation procedure. He said that about 10 years ago, urolift was all the rage and it was used for all sizes of prostate glands (now known to be effective only for small ones). Implication is that urologists didn't know any better then and were predisposed to trying the latest treatments.

@bennysr thanks for the reply. It’s strange the build up is there and then nothing comes out. It’s like trading for a marathon, running the race and just before crossing the finish line you stop.

Two question to those of you who whent through Aquablation:
1. Were you fixed in a scanner during the procedure, or
2. did the doctor use a microsound device in the rectum?
I just wonder if the first is more safe than the second?

@sorentj
This is a re-write of my earlier reply.

1) Yes, there is a separate probe inserted in the rectum to create an image of the prostate gland. I think this is what you refer to as the "scanner" and the process by which it creates the image is by ultrasound or "microsound."

2) There is a separate "robotic handpiece" that has a camera and nozzle for the high-velocity saline water that removes prostate tissue targeted by the urologist.

@bennysr Is it possible the hematuria is due to some other condition, not the Aquablation? I don't like your urologist's reaction and it sounds like he's going on a fishing expedition. Why not try a different urologist, preferably one with more experience.

@mkaften
Thanks for your reply. I agree that there may be causes other than the procedure itself. The cystoscopy procedure he prescribed, as I understand it, might be the ultimate fact-finder. I have a friend, however, with BPH who was later found to have cancer of the bladder and not the prostate itself. A cystoscopy might miss that possibility. Thinking maybe a cystoscopy and an MRI would be more thorough for diagnosing my condition. Bladder cancer, I've read, can also cause hematuria. I'll report back on developments. Thanks again.

I had Aquablation about 3 months ago, and although my BPH symptoms are mostly gone, I'm still not 100%. Peeing stream is now strong, although there is still some urgency. I clearly have a long way to go.

After reading about many people's experience with the procedure on this site, I've come to several conclusions. Number one is that, contrary to popular belief, there is no such thing as a "standard" post-op experience. Everyone will have different outcomes, and time to full recovery varies. If your outcome was different from lots of others, that isn't necessarily anything to worry about. The prostate requires a lot of time to heal, significant swelling can go on for a time, and bleeding may continue. Urination will normalize, but this may take much longer than anticipated. Perhaps there is not enough publicizing of these facts. Most men go into this with certain expectations, most of them based on advertisements on the internet, and explanations of the urologist. In fact, the outcome depends on a LOT of variables, among them:

-the expertise and level of experience of the urologist/surgeon (this could be the most critical factor),

-the size of the prostate,

-the amount of tissue removed,

-possible nerve damage,

-the length of time that the catheter is in place,

-the reason for the length of catheter time,

-the condition and health of the bladder,

-the condition of the urethra and how much damage was done in the procedure,

-the amount of physical or sexual activity and how early after the procedure it began.

I believe that urologists should be more up front about the fact that the outcome has a lot of unknowns. I'm still glad I had the procedure, but I'm disappointed that I only found this web site after going ahead. This site has been extremely valuable.