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.