Aquablation: Post-surgery expectations

I'm posting the highlights of my post-aquablation experience in case it helps anyone wondering how it's like after almost 5 years. Here we go:
~Early 2021, I experienced full blockage and had to go to the ER twice
~Told my urologist I need a long-term fix without removal ("prostatectomy")
~Urologist recommended aquablation based on my prostate size of around 140 grams. Smaller size calls for other procedures
~I agreed and had the procedure Sep 2021 after a cystoscopy confirmed no cancer
~General anesthesia and overnight hospital stay for continuous bladder irrigation meant to prevent clotting
~After post-surgery catheter was removed, some feeling of rawness and pinkish urine but both went away after about 10 days
~While urinating during this period, experienced blockage again. Strong pushing expelled a big blood clot and all was good
~Sometime 2023, I had blood in urine. Urologist prescribed an MRI w/c didn't happen because my insurer delayed approval and the bleeding had stopped
~I had bleeding ("hematuria") once every quarter from 2023 to 2025 but it would come and go within a day
~Wanting to resolve the bleeding, saw my urologist again in late 2025. He performed a cystoscopy but let me know my "4Kscore Test" was 54%, way above the safe upper limit of 7%
~A 4Kscore Test is a regular PSA test x 4 as a cancer predictor. However, I wasn't instructed to stay away from multivitamins 3 days before the test. I learned later that continuing MVs up to the day of the 4Kscore Test can produce a false positive, which happened in my case
~Based on my above test result, urologist - not aware of the multivitamin's false positive effect - ordered an MRI which this time was quickly approved
~MRI results showed negative risk of cancer, a big relief
~Urologist's opinion is that my oversized prostate, while non-cancerous, can be causing the occasional hematuria
~Cleared of the cancer risk, urologist recommended an annual checkup

Hope these insights will ease some people's anxieties or at least answer some questions!

@albiet I had my aquablation on April 9 and spent one night in the hospital. I went home with a catheter and did not get the catheter removed until April 14. I had some blood in my urine until around April 27. No blood in my urine since then. And, the amount of blood was less and less as I approached April 27. Last night (May 6-7) I had a good night's sleep -- 4.5 hours solid. That is my first 4+ hour sleep period in many, many months. In fact I can't remember the last time I slept that long without getting up and going to the bathroom. So, it's probably been a few years for a block of sleep time that long. Prior to my aquablation, I routinely work up every hour or 90 minutes throughout the night. Some nights getting up 7 or 8 times just to pee. Now, I'm starting to only get up twice in each night. 🙂 This is excellent news for me!

Update- I had my acquablation on 4/27 and cath removal 4/27.
My peeing has been mostly starts on stops, some spreading of the pee, hard to start and lately feeling of always have to go pee. My surgeon can’t see me until Monday so went to my main uro. He said the scan shows about 185ml pvr and no clots. He said it’s a major operation and you should have at least 2 weeks of hell before you get better. He also tried to show me how to self catch but couldn’t do it( nor could he because of a false passage). Definately made the prostate more sore.
After the visit I felt that I just need time to make this work. Unfortunately , last evening my peeing basically stopped. I was feeling intense pressure. Any pee that came out was dibbles.
After 10 hours of not peeing I planned to go to er this morning, but said to myself I should try to self cath just Incase I can get it to work so I won’t have to go to ER.
To my surprise I got it to work. I had a very full bladder as 600ml came out. Hoping that I can pee again before Monday when I see the surgeon

@albiet sure isnt like all the You Tube Doctors sites saying how easy Aquablation is just a little discomfort. Sure isnt a walk in the park! As of now wouldnt do it again.

@albiet Good you were able to self-cath because it's really an emergency life-saver. Myself was concerned before using it but ultimately found it to be painless. The continued retention though is a concern in my opinion. If I'm not mistaken most of us here have experienced almost immediate and progressive improvement as time goes on. I think you'd want to press your surgeon for resolution. In my case, my uro also performed the surgery. Best of luck!

@bennysr
thanks. i dont want to think in the negative yet. i have a visit with the doctor on monday morning. Cathing was lucky for me as i have a false passage. i was on my 2nd and last try before i was going to emergency room.
larry

@bennysr
just spoke with surgeon, he is not concerned. (I did have a badder scan yearterday and it showed no blood clots.) he want me to try and continue cic until monday appointent if necessary but thinks i should be feeling better by monday with swelling going down.

larry

Undergone Aquablation Therapy for Benign Prostatic Hyperplasia report that recovery is generally smoother and less painful than they expected compared with older prostate procedures, with most experiencing improved urine flow, reduced urgency and less nighttime urination within days to weeks, although the first couple of weeks can still involve temporary burning during urination, urinary frequency, mild bleeding or clots, and short-term catheter use while healing occurs, and one of the major advantages often discussed is that Aquablation appears to preserve normal ejaculation better than traditional surgeries like TURP although retrograde ejaculation can still occur so given your good health, moderate enlargement and reassuring PSA history, you sound like the kind of patient who often does very well with the procedure and many men in similar situations say the quality-of-life improvement was worth it after years of only partial relief from medication.

@elglide everyone has a different experience. For me after 24 hours the catheter was removed and it was pretty minimal discomfort after that, but some people struggle.

@toorom
Hello,
I have had an indwelling catheter for seven weeks now and still have at least five weeks to wait while having a while having an indwelling catheter before I can get aquablation surgery. I was wondering if you experienced any urinary tract infection infections while you had the indwelling catheter for three months. I’ve been trying to do everything I can to prevent infections, but I’ve been told they almost always happen. Thanks, Rick