Aquablation: Post-surgery expectations

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.

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

Not to have to wake up and find out that a resident in training did it! Don't know if my surgeon who I thought was doing it and had been seeing was there or not?

Then 7 months later after another scoping said stuff still in there, not new growth and do I want a revision surgery. So far I have done nothing but go back on Flomax.

@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?

@sorentj

Good evening! My procedure was done in Tucson, AZ. Dr Patel was the urologist. I do not know what instruments were used. It is my understanding the procedure is a standard scanner in the rectum to guide the probe that is going to remove the tissue. Hope it helps!

Seems that some people had catheters in place for up to 7 days, where other people had catheters removed after one night (me included). The entire night was spent in the hospital, flushing out my bladder with saline fluid. 3-liter bags would empty into the catheter about every two hours, and would drain into another bag...when the saline bag was empty, a nurse would come in with a new bag and empty the drain bag, and it seems like this was repeated at least 10 times. At the beginning, the drain bag was deep red ("Hawaiian Punch" as the nurses called it). By morning it was only pinkish. The catheter was removed and shortly after, I could pee normally, with some blood mixed in. I was sent home at that point. Pinkish urine lasted about two weeks, with a burning feeling which was uncomfortable but not extremely so. The burning feeling faded away after a few weeks. Now, about 3 months later, I still have mild urgency, but not extreme urgency. It gets better all the time. Stream is strong, but occasionally not so strong. It varies, slightly worse overnight.

I'd like to know why some people need a catheter for a week, and others only a day, and if this has anything to do with any negative after-effects.

Seems that some people had catheters in place for up to 7 days, where other people had catheters removed after one night (me included). The entire night was spent in the hospital, flushing out my bladder with saline fluid. 3-liter bags would empty into the catheter about every two hours, and would drain into another bag...when the saline bag was empty, a nurse would come in with a new bag and empty the drain bag, and it seems like this was repeated at least 10 times. At the beginning, the drain bag was deep red ("Hawaiian Punch" as the nurses called it). By morning it was only pinkish. The catheter was removed and shortly after, I could pee normally, with some blood mixed in. I was sent home at that point. Pinkish urine lasted about two weeks, with a burning feeling which was uncomfortable but not extremely so. The burning feeling faded away after a few weeks. Now, about 3 months later, I still have mild urgency, but not extreme urgency. It gets better all the time. Stream is strong, but occasionally not so strong. It varies, slightly worse overnight.

I'd like to know why some people need a catheter for a week, and others only a day, and if this has anything to do with any negative after-effects.

Seems that some people had catheters in place for up to 7 days, where other people had catheters removed after one night (me included). The entire night was spent in the hospital, flushing out my bladder with saline fluid. 3-liter bags would empty into the catheter about every two hours, and would drain into another bag...when the saline bag was empty, a nurse would come in with a new bag and empty the drain bag, and it seems like this was repeated at least 10 times. At the beginning, the drain bag was deep red ("Hawaiian Punch" as the nurses called it). By morning it was only pinkish. The catheter was removed and shortly after, I could pee normally, with some blood mixed in. I was sent home at that point. Pinkish urine lasted about two weeks, with a burning feeling which was uncomfortable but not extremely so. The burning feeling faded away after a few weeks. Now, about 3 months later, I still have mild urgency, but not extreme urgency. It gets better all the time. Stream is strong, but occasionally not so strong. It varies, slightly worse overnight.

I'd like to know why some people need a catheter for a week, and others only a day, and if this has anything to do with any negative after-effects.

@mkaften this is the biggest problem, but also the biggest reason for success with aquablation. Because there is no heat compared to other methods there is less risk to successful outcome, but it also means more bleeding because the procedure itself doesn't cauterize vessels. Here's my guess. So the doctor has to manually do it which is not a effective. The bigger the gland perhaps the more opportunity to miss something. Maybe luck plays a part. I believe this is why the practice that did my procedure does PAE just before the aquablation, studies have shown or to be a very effective way to reduce bleeding and quicken recovery. I'm not advocating for the procedure, i had my concerns, including the additional risk of the PAE procedure, but my recovery was only 24 hours with the catheter and I had very minimal bleeding after. However, the PAE wasn't a breeze either. The procedure was easy, but there is a lot of initial inflammation which was painful and because I had a large median lobe I nearly lost the ability to urinate before the aquablation which was 5 days after PAE. Certainly there are horror stories, but most regular aquablation seem to have minimal bleeding and a catheter for only 2 to 3 days. I looked at it this way, my enlarged prostate want going away, it was only going to get worse, so it's a risk I had to take. Delaying only increases the risk and worsens the outcome of the procedure. Just one guys opinion.