Aquablation: Post-surgery expectations

@art12 very happy to hear. Im 2 days short of a month. Flow is not strong, feel alot still left in. i was waking up twice during the night and peeing like 150ml each time. now sleeping 6 bours but still waking up and only doing about 150ml. need to do multiple pees and still feel bloated. anyone -does it improve over time?

I’m now over 5 weeks from my operation. Last week was terrible. Needed to cath myself. But what a difference a week makes. Since then flow has improved. Able to sleep only getting up once at night. The main issue I have is urgency. When I feel like I have to go, I have to go.
There is one thing is weird. I have been getting lower back pain when I pee. My question to all of you, does anyone here get some back pain when you pee?

Final Update (Tried to post this a few days ago, but system wouldn't take it so perhaps it was too long-Fair warning!)
Those who posted here were a great help to me in my recovery from Aquablation. Any problem you might have in your recovery there's likely an answer here so here's my final wrap of my story before I look for the off button:
Background. Age 65, BPH began around 49 and diagnosed with a slightly enlarged prostate. Somewhere in my mid 50's starting seeing a Urologist at my PCP's suggestion. Put on Taladafil and Tamsulosin which worked effectively for a while, but by my early 60s started to struggle. Had a combination PAE/Aquablation procedure Sep 2025. PAE followed by Aquablation 5 days later. This procedure reduces the bleeding associated with Aquablation significantly (only catheterized for 24 hours) and potentially extends the effective life of the Aqua results. Some blood in Urine first week, disappeared second week, bleeding again third week (started being too active too early) then bleeding stopped in 4th week never too return. I did continue to occassionally pass a small bit of scab up until about 2 months. Flow was outstanding to start, but waned after 3 months. At now 9 months I feel my flow rate has stabilized about half of the early results, but I still generally get up only once a night. I didn't experience RE initially (first sex at 4 weeks), but though I now get a very small amount of ejaculate I would consider it RE now. Notes:
1. I WAITED TOO LONG. My original URO never did a cystoscopy in over a decade and when I brought up various options he always dismissed it as not necessary yet. In hindsight that was awful advice, but (IMPORTANT NOTE) like many of us you didn't have to tell me twice. Nobody wants prostate surgery so I allowed myself to be misled. When he retired and I went to another Uro practice they immediately did a cystoscopy, found I had a large median lobe and about 94cc prostate. Recommended PAE/Aquablation combination which I had only 2 months later. NOTE: My bladder had suffered damage due to years of delaying. While I'm generally happy with my results they would have likely been much better if I had acted earlier.
2. DON'T LET FEAR DRIVE YOUR LACK OF ACTION. Your problem is not going away, it's only going to get worse and your lack of action is damaging your bladder. Many people I read about here have done just that and now suffer the consequences. One of the prime reasons I read about is fear of RE. There are worse things much worse than the risk of RE. I've read about guys choosing to self cath rather than undergo a procedure for fear of RE. Most of us would prefer not to have the RE, but it's a minimal inconvenience in comparison.
3. LARGE MEDIAN LOBE. Had I read more I would have realized this was my problem, but my original URO never discovered it because he never did a Cystoscopy. The main symptom is the large median lobe acts like a ball valve and the fuller your bladder the harder it is to go. For example if you put a rubber stopper in your tub and run just a little water you can pull the plug easily, fill it with water and it's much harder. If I had to delay going to the bathroom (long drive, no restroom access) I would really struggle to start to go. This is a serious issue that many men with BPH have and less invasive procedures are likely not an option. Luckily I had a great new URO who even though he performed Urolift advised me it would not work for me and referred me to another great doctor who did Aquablation. He advised me to do the PAE/Aquablation combo which I found out later they recommended for larger prostates (there's a google study on the combo procedure, just google it). Bigger prostate, more tissue removed, more bleeding.
4. THE AQUABLATION PROCEDURE IS RELATIVELY PAINLESS FOR MOST. The PAE was super simple too, performed under a mild sedative I was awake for the whole procedure. However my discharge nurse informed me that it would get worse before it got better which it definitely did. The PAE inflames the prostate and my BPH symptoms quickly got much worse as did the pain over the 5 days until I had the Aquablation. The Aqua was much easier by comparison. I had very little pain, just some minor burning during urination that subsided quickly in the first week. I didn't even use the numbing medicine they gave me after a few days.
5. RESULTS. Like most my urine flow was much better immediately after surgery and by two months was very steady. I will say my flow rate subsided in the months that followed and I still sometims have some very minor almost imperceptible sensation in my perenneum and urethra. My Doc said at the 6 month follow up it might be some scar tissue and that we would keep an eye on it. Said he might do a cystoscopy at my next annual if the symptoms persist and there could be some follow on procedure needed (He didn't expand on that I didn't ask). I have no leakage, but do have increased urgency and frequency, some of the source is physical (reference bladder damage due to delay) and some is mental. I need to go typically every 2-3 hours, but only get up once most nights. If I get busy working on a project and forget about it I might go 4-5 hours some times. Inversely sometimes my overactive bladder kicks in and the symptoms will be worse for a few days, but it's generally short lived. I do consider myself to have RE even though the doctors might not technically qualify it as such, but I had it with the Tamsulosin as well. I can delay if I need to, the urgency is still there though. I did try Pelvic Floor therapy. I found that my core is actually pretty strong, but they did give me some good techniques for the mental part, namely diaphragmatic breathing and toe tapping, both of which are pretty effective.
Well that's everything I think. I'll stick around for a couple of days to answer any question and then I'm headed for exits. I think it's time to stop thinking about it and get on with my life. Thanks to those who post here for the help, hope my final notes help others.

I am 4 months today, am doing pretty well. Only getting up 1-2 times a night! Finally got in to see my doctor yesterday. Flow is excellent. Still have to be on Mybectrin as I get urgency and leakage without it. On the whole it wasnt an easy experiance but really not too painful. I dont have to worry about finding a bathroom all the time now either. I am moving on now and putting this experience behind me. Hope everyone has a good outcome in the end it was worthwhile just not as easy as the Doctors on you tube make it out to be!

@vtredwolf your story very similar to my story…and I too feel very fortunate I finally moved forward with aquablation surgery. RE has been my experience as well and almost exactly as you have described…however the trade off of being able to enjoy a more normal way of life otherwise has been more than worth it. I’m some nights literally sleeping through the night without a bathroom trip…and during the day things have also normalized. I too was lucky that my hesitation of addressing my issue for years did not lead to permanent damage of my bladder. Tamsulosin was helpful for years but contributed to my almost waiting too long to have surgery.

I’m curious of what you’ve been told by your doctor regarding regular follow up and testing yearly. I had surgery in Austin TX but live in Phoenix. I’ve found a new Phoenix Urologist with experience in aquablation surgery…but first appointment not until August.

Congrats on your outcome and thanks for your past posts…I learned from prior to my surgery in February 2026.

@b140 after my final 6 month follow-up, my doctor said see you in a year for routine check up. I think you could go to most any doctor. He did tell me that the prostate starts growing again after surgery. The PAE might slow it down a little in my case, but he said it should last me 10-15 years before I might need another procedure. If I live that long who knows what improvements they might have come up with.

Do not delay a prostate reduction procedure (Holep, Green Light, Aquablation etc) once you have these symptoms, by taking medication! Forget the medication; go straight to see a urololist to get one of the new generation (excludes TURP!) procedures done to reduce the prostate. The longer you put up with the "plumbing problem". the more damage the bladder will suffer coping with the "blockage" such that this bladder damage will compromise the prostate reduction you will get - you will NOT get the best outcome if you present for the procedure with a damaged (sacculated) bladder - years of blockage abuse. The MEDICATIONS to shrink the enlarged prostate compromise cataract surgery later in life should you have this issue. So beware!

My Cystoscopy is Friday and the Doc expects to recommend Aquablation. As I begin this journey thanks to all of you for making me feel better about the whole process! We old dudes need to stick together. I cannot imagine a night without 4-5 trips to pee, no more meds, and maybe even a little surprise for my wife! 73 years young.

@vtredwolf yes...given AI and all the advances in medical science...maybe future procedures will become even easier. I specifically asked the same question of the PA I had my follow up with and was given the same 10-15 year answer you were given...but that results from aquablation are still being compiled.

@psblin99 Well glad that is over. Piece of cake. Maybe day old cake. Two women in the room and a tube in by penis, but it was ok just a little uncomfortable. Looks like Aquablation is the answer. Size was about 95 and I am told 40 is normal. Hoping for good results! I will keep you posted.