Aquablation: Post-surgery expectations

@jaemiami Mixed. I had mine done on Dec. 18th. My prostate was larger, but not enough to cause full liquid stoppage as some here have described. Mostly, I was tired of the dribbling, thinking I was done, and moments later felt some extra "warmth" in my underpants.

Meanwhile, while the amount of dribble has decreased, it has not gone away. And, that "warmth" issue has only happened very few times since. I do not know if that will continue to decrease or increase. I see my doctor for the first time after the surgery in two weeks and have that and a few other questions then.

As far as needing to urinate, this is also a mixed bag. There are times when I can go hours, and times when I'd like to go much sooner. I have read that the bladder can constrict with repeated urination and not relax to be capable of holding more. It is a muscle and needs to be exercised, so I try to hold it as long as I can. However, I do have a tipping point where I cannot hold it in and start dripping before I can drop my pants. These have become less frequent enough that I have stopped wearing pads. However (#2), if I'm going out and may not have immediate access to restrooms, I then do wear them. Nonetheless, I go to bed around 11-ish and can last the night to around 6:30-7:00. So, that's a biggie.

This is my story at this point.

@jaemiami have you considered pelvic floor physical therapy? I'm 6 months post aquablation and am doing it now. Some people have significant results from PFPT. My surgeon told me that 3 months was the point when results would stabilize though some marginal improvements were still possible. Also I've been told to reduce the caffeine, carbonated drinks and citrus

@vtredwolf Thank you for your suggestions. I have considered PFPT but at this point my surgeon doesn't think it's appropriate for me at this time. I go easy on the caffeine, and I don't drink carbonated drinks. I am being scheduled for Urodynamic testing to see if it's related to my bladder.

@garysc You wrote that the bladder is a muscle that needs to be exercised, so you try to hold off on urinating. I recall that I was told not to hold it but to urinate when I had an urge. Perhaps your situation is different than mine. You may want to check with your physician about whether hold it is beneficial or not.

@kocour, thank you, I will (and was already planning on asking him that). I have a host of questions for him, and this was one.

I had Aquablation on 1/26, I had tried PAE last May but didn't get good results. The Dr who did the PAE said I had plaque on one side of my prostate and he couldn't insert the pellets due to that. I am a healthy 67, was on Flomax and Finesteride for years due to BPH. My prostate was 90 grams. I had the aquablation, stayed 1 night in the hospital, went home with a catheter. I had several clots pass the first 2 days, that was the only pain. I had an appointment scheduled for follow up on day 4, my Dr said I could take the catheter out, he just didn't say when. It was really hard to sleep with it, my urine was clear, so I removed it after 72 hours. Went to my follow up, my stream was better than it has ever been and no issues. My Dr released me for exercise after 4 days. I am 5 weeks out now, in the last week I have had to run to the bathroom when I had to go, that had been much better. Has anyone experienced this? It's not every time, but the urgency is there worse than ever. I sopped taking the meds after my 4 day follow up, maybe they are finally getting out of my system?

@mikegold I had Aquablation done in August at the Mayo Clinc. Afterwards I experienced some urgency. When I had a follow up with my physician's team three months after the procedure, I was told to avoid carbonated beverages, caffein, and alcohol. I only drink alcohol and coffee on very rare occasions. I had been drinking lots of canned sparkling water, because the tap water in Iowa has high levels of nitrates. I stopped drinking carbonated water and my issues with urgency immediately stopped.

Thanks, I appreciate it. It's just strange that I wasn't having urgency issues immediately after the procedure and then they started after 4 weeks. I called my Dr's office, they are having me come in for a urine sample to be sure there is no infection. Don't think I am willing to give up coffee and alcohol.

Hi Folks. I have what I think is new info and so wanted to post this.

First, some background w/c some of you might already know from my old posts but since there are new forum contributors, could be beneficial.

I had aquablation in Sep 2021, which makes me 5.5 years living with the results. My early experience mirrors a common pattern among us in the forum: significant improvement in urine flow, much less bladder retention, overall better quality of life.

2 years later, in 2023, I had blood in urine w/c my urologist addressed with an MRI. I didn't get an appointment confirmation from my insurance carrier and the bleeding stopped after a day, and so I didn't follow up with my urologist.

In late 2025, I again had blood-tainted urine. In all, I'd have what's called as hematuria - blood in urine - about once every 3 to 4 months with urine clearing up after one day. I saw my urologist who prescribed a cystoscopy. That's it for the backgrounder.

After my cystoscopy 2 weeks ago, my urologist said "no cancer found." I was relieved. Went back yesterday for the post-op check-up.

Urologist then informed that just to be sure, he had a "4KScore" test done from blood drawn - I assume - during the cystoscopy. Turns out, on the test's scale of 0% to 95% that indicates the presence and aggressiveness of cancer, I scored 54% which far exceeds the "low risk" score of 7.5%. After discussing my "life goals" (reach 92 years based on my personal genetics and family history), my urologist and I agreed on a management plan based on a new MRI to confirm the 4KScore finding.

Receiving a lot of information but still having questions, I researched and found that multivitamins, specifically the ingredient biotin, can produce false positives. The protocol apparently requires not taking multivitamins 3 days before the 4KScore test. I'd not been informed about this and so was taking MVs up to the day before the test.

I'll still proceed with the MRI and will at some point advise my urologist about the MV and biotin warning. I believe more than the urologist, the pre-op surgery team should have been aware of this. However I'm letting it go because, false positive or not, I'd like the MRI to provide final judgment.

The 4KScore and the false positive warning are the new info I wanted to share with everyone.

I'll give an update after getting the MRI results. Cheers everyone.

Update on my aquablation surgery on 2/25/26 in Austin TX w/ Dr. David Cuellar @ St David’s S Austin.

As mentioned in previous posts, I traveled from Phoenix for this surgery as the surgeon came very highly recommended, well over 2k aquablation under his belt. The surgery in Phoenix would not have happened until early April and they were leaning towards the Holep. Wanted to address asap as I’d been self catheterizing 4 times daily since mid December and was tired of the ball and chain of that routine.

The surgery was performed at around 9a and a spinal anesthesia was utilized. Going into, had no idea of that type anesthesia process but it turned out no big deal. In recovery I experienced a heart rate drop for around 30 minutes but was brought back to norm relatively quickly and said to be associated with the anesthesia. Spent one night in hospital w/ catheter. Throughout that stay and for the next 6 days, flow into catheter bag remained of a fruit punch color which I was told optimal. Released and spent next day in hotel room w/ a friend then moved into a relatives apartment downtown. Over the next few days I used a 562ml leg bag during day and each night switched to a 2000ml bag at night. No surprises, blockages or any other concerns for next days up to my follow up appointment w/ nurse practioner 3/03. On 3/03 my bladder was tested by fillin my bladder with 240 ml of solution (to a point my bladder gave me the immediate urge to void), then the catheter was pulled and about a minute later I was able to void 300ml…more than passing the test! Was a huge relief to see things work normally. With that result I was told that I would need to stay in town until a new 3/13 appointment for urine flow and retention testing. On 3/04 I began having issues voiding and had to use a self catheter 4 times between 800p and 9a the next day when I made an appt to be seen. In the 3/05 appt a bladder flush was done and returned no negative results of a blockage. Was told the partial retention starting 3/04 may have been result of post surgery inflammation or start of a uti. I also had seen small particles in urine which may have been scabs creating a semi block. (Waiting over the weekend for results of a ur analysis). Did fine from afternoon of 3/05 after the flush appt thru afternoon of 3/07. Then around 700p 3/07 starting voiding what appear mostly blood. Immediately called after hours doc and they pushed drinking even more water and to start using Cipro med previously prescribed. (I’d held off starting to use this 3rd round of Cipro rx in the span of a month and a half until I was able to see results of 3/05 urinalysis). By 1100p the eve of 3/07 my urine was once again near normal and flow returned at very near normal. More scab debris noted in urine. This morning things seem to have normalized after a good nights sleep with around 4 overnight bathroom visits after consuming so much water. So far, I’ve avoided any emergency room visits and feel like things may be healing normally. Hope to leave Austin back home to Phoenix 3/14 after going to the testing appt on 3/13. Overall very pleased with results of aquablation so far but also know to be ready for minor roadblocks along the way in coming weeks. Size of prostate by the way was 49g noted by surgeon. I’m 65 yes old and had a large median lobe protruding into bladder prior to the surgery.