aquablation and retro ejaculation

@albiet I had some pre-surgery history w/ UTI's for a few weeks. 2 months before surgery I was at a point I could not void whatsoever due to the median lobe acting as a ball valve. I had to self catheter for those 2 months and that led to a couple of UTI's. The surgery went well, no pain whatsoever and the catheter was left in for 6 days. At the point the catheter was removed...everything worked beautifully for a couple days. Then another UTI arose...or what felt like the UTI's that I'd had prior. To this day I'm not sure it was a UTI as the lab never correctly processed the urine sample for a proper culture. I was however prescribed Cipro and the issue went away (a bit of burning and very low to no flow rate prior to the cipro). Then about 11 days later the same issue occurred again and I had to seek medical attention through the emergency room at hospital. They admitted me and put me on a different antibiotic intravenously along with a saline solution to hydrate. Between the antibiotic and the saline for hydration...I was almost normal again withing a very few hours. They had taken another urine sample and it had given signs something was off...but 2 days later the culture came back negative for a UTI. My surgeon believes both times I thought I had a UTI was more likely an issue with not enough hydration. Seems hard to believe given the water I was putting away. Since that hospital stay for 3 days...and greater attention to drinking even more water...I have improved slowly to a degree that I'm nearly 100pct in the way I feel and able to void like years ago. As mentioned, It took nearly 8 weeks to really feel a huge success...but in the end it's been worth it. Super important to really down the water. RE the only negative so far.

@b140 thank you. when you went back and we in the hospital, did they but a new foley in you to check to wash the prostate out or check for clots?

@ken224 I am 9 weeks out now still have urgency and leakage, Ejaculate is fine though. Doctor has put me on gemtesa so we will see if it helps. My prostate was 99 grams. Had ok flow before procedure better now, only improvement I see! not to happy yet everyone says wait awhile hope things improve.

@elglide Be worry of any med that relax the bladder if you are trying to avoid retrograde ejaculation. Aquablation alone should have corrected urine flow and emptying of bladder

@albiet the first two weeks is very early. It was four weeks before things calmed down for me. Limiting your activities can really help. At six weeks I felt I could spend an afternoon picking up small branches and hauling them to a burn pile. That was too soon. I got very sore and had some bleeding. Take it easy and be patient.

@connect4321 thank you for the kind reply. My main concern is it’s still very hard to pee. I’m not sure if it’s because I’m still inflamed, there is any blood clots or anything else. I am peeing but it’s hard to start and usually 20- 100ml. I’m 9 days post op, so I wondering if what I’m doing as expected or whether I should be able to pre better

@albiet
It does sound like you are obstructed from something. Are you able to message your urologist’s office for some help? It’s important you dont slip into acute retention (cant per at all). If that happens go to the ER right away.

@connect4321 thank you. i put a call in them and waiting for a reply

Hi gentlemen,

I can comment on a few of the posts.

RE (retrograde ejaculation) or Anejaculation (no fluid at all - so men don't see the ejaculate in their urine when they void after orgasm) is sometimes an unavoidable consequence of even the most apical tissue sparing BPH approaches. The trap door that keeps the fluid from going back into the bladder is thought to be at the part of the prostate closest to the sphincter or "check valve" which attaches to the urethra. The opposite end of the prostate that connects to the bladder is thought to not be very vulnerable for either problems with ejaculation or erections.

Treatments that try to spare ejaculation essentially minimize operating on the area where the trap doors exist. Aquablation uses transrectal ultrasound in real time to 1. spare the tissue near the verumontanum (also referred to apical tissue) to leave the important tissue behind and 2. optimize depth of resection down to but ideally not through the prostate capsule. So how is it then that men could possibly lose ejaculation after aquablation? First, we are not entirely clear of the mechanical mechanism that is actually happening (i.e. what apical tissue is the most crucial to spare)- this lack of understanding probably leaves us a bit vulnerable. Second, the prostate has a very generous blood supply - there is a whole line of BPH approaches which tries to address this - PVP laser and Rezum steam therapy typically cause much less bleeding. BUT, most BPH procedures use a conductive heat source to eliminate tissue. As the name implies, we treat one area but unbeknownst to us, the heat is damaging parts of the prostate we don't see it melting in real time. Aquablation uses a water jet which is not heated - this is theoretically better since the computer only eliminates the prostate it is programmed to (like a deck pressure washer clearing of old stain). So, the question remains why do men get RE after aquablation? Because the prostate has such a good blood supply, once the pressure washer is done, one has to look back into the prostate and stop the bleeding. Like most bleeding in surgery, this is stopped with cauterization (conductive heat source). Thus about 10% of men require aggressive cautery near the apex which unintentionally damages the ejaculatory mechanism. The only BPH approaches that have Zero RE risk are mechanical, non-heat sourced approaches like: Urolift and Itind. Rezum has about a 5% RE rate in my hands because it uses convective heat (steam). The problem with Urolift and Itind and to a lesser extent Rezum is durability - because you are not eliminating all the tissue you can, sometimes the treatments only last a few years before symptoms return.

Regarding urinary symptoms after BPH procedures, this is almost universal. For whatever reason, people think surgery these days will not include pain or post op discomfort. This is patently false, modern medicine does its best to minimize these complaints but the body does takes time to heal and return to close to normal after prostate tissue is destroyed in some form (but sometimes never back to totally normal). This process typically takes 4-6 weeks but I have some patients that take up to a year for their bladder and prostate to calm down.

Finally, if you experience RE after bph surgery, can normal antegrade ejaculation ever return? Rarely, the trap door tissue grows back and normal ejaculation is restored - but this is rare in my experience - < 10% of the time. Luckily most men with changes in ejaculation still enjoy orgasm.

Best

Dr Kohler
Mayo Clinic Men's Health

@albiet so my aquablation surgery was 2/25/2026 and surgical catheter removal was 3/3. Results at the removal were excellent until the night of the 4th. Went back to surgeons office 3/05 where they did a bladder flush since I was having issues voiding. The bladder flush results showed no issues or blockage. Left without a catheter need and up until the night of the 7th...voiding continued halfway normal. Prior to the appt on the 5th, I'd tried to self catheter on the 4th but there were no results in voiding. It's like my body was absorbing the water I was drinking and was apparently dehydrated. By the time I was scheduled for my next follow up appt on the 13th, I'd seemingly normalized and things felt good again. Then on the 22nd...the same issue of not being able to void came back...and still no results when trying again the self catheter. On the night of 22nd, went to ER where the initial urine test taken showed results that were out of whack in 3-4 readings. On top of that, even though I felt like I needed to void...two testings in the ER showed no urine in bladder. I was admitted for 3 days until the urine culture results came back (which take 2-3 days). Those results were negative for UTI. Ultimately it was determined I was just dehydrated and with the course of further antibiotics plus the saline...I was feeling 10 times better the early hours of the 23rd. Since my ER release on the 25th March, I've slowly returned to almost complete normalcy. Never had a foley re-inserted beyond the surgical catheter 2/25.