Aquablation: Post-surgery expectations

How many weeks when everything went to normal? Mine was done on June 24 and still experiencing overactive bladder. Did they do anything with the overactive bladder or it just went away on its own? Thank you and very happy for you that everything is back to normal.

As long as my catheter (SPC) was in place, I couldn't empty my bladder sufficiently. I had a high PVR of over 200 ml. However, after the catheter was removed, my bladder came back to life. Now, I suddenly had a low PVR (measured by ultrasound) and needed to pee often. After a few days, I tried to suppress the urge, especially at night. My bladder had to "learn" to tolerate a higher volume. This took another four weeks. In your case, your PVR should be checked. If it's already fairly low, you're definitely on the right track. It will still take some time, but your bladder will settle down.

Sorry not sure why do you mean by PVR.

My apologies. "PVR" stands for post-void residual (volume), the volume remaining in the bladder after urination. In context, it's the same as "PRV"...

Okay. When I had mine done it was zero.

Not true. Been in practice 30 years. 99% of docs will tell u what is best. Egregious to assume docs don’t mention options because of competition. Most of us have plenty to do. Also, we do not get kickbacks, do not get paid to prescribe certain medicine. We don’t get paid for referrals. We are not in cahoots with anyone Yes there are some lowlifes out there but I’ve know 100s of docs—maybe several put their wants over patient care.
Just had aqua ablation. Recovery rougher than expected but I’m peeing great now. I do have an unusual symptom I hope goes away soon—erectile pain. Thought I was done w spontaneous erections but getting them now and they hurt like hell. Has only been a week. I believe aqua will replace other bph therapy. PAE can be very effective but often fails after a couple years.

@aero Thank you for your MD insight. There are a few bad apples out there that taint opinion but I agree most are deeply caring providers. On the other hand, they do what they do best with their training. If they don't do X, it probably because they were not trained/experienced with it.
I just had HOLEP in June and doing surprisingly well. Some bladder retraining as its still overactive, no incontinence, great erections and Cowper's fluid but retrograde ejaculations. This will take some getting used to but at my age something that I experience once or twice a month vs 200-300 times is a good trade off for me.
Your erectile pain is a "good" pain. More blood flow, nerves coming back on line. My first orgasm was "painful" but so much better now.
Aquablation is a great choice for some. It has some downsides also so I don't think it will ever replace HOLEP. Most the other options just kick the can down the road. For durability, any size prostate, lack of bleeding, minimal post op pain and the greatest tissue removal with highest PSA reduction, you can not beat HOLEP.
Keep us posted how you progress...

Thank you for sharing your experience. You make very good points regarding the positive aspects of holep. I would just add they are trying to make holep even better by using lower energy levels (50 watts vs 100 watts) which helps to reduce unwanted side effects caused by heat. The lower power treatments seem to be equally effective. It might be a while before these lower power offetings become more common.
https://journals.sagepub.com/doi/10.1177/03000605241304542

Aged 65, had aquablation (in London) 14 weeks ago, just had to have TURP to fix complication due to a band of tissue blocking urethra.

So mine is a story of what can go wrong. Recover from aquablation was slow (extra 10 days on catheter as went into retention) and from around 4/5 weeks it was obvious that I was way off the recovery curve and there was a problem. Things were going backwards. Painful to pee, weak flow. Surgeon kept kicking ball down road with talk of 'time to heal', 'Let's give it a few more weeks', 'I'll give you some different antibiotics'.

At round 11 weeks did another flow and PVR which showed the Qmax the same as before surgery and residual urine also at pre-surgery levels. The flow rate pattern looked obstructive to me (or rather Google), but surgeon didn't mention his view. He just said it was below average.

More surgeon chasing and updates - Flexible cystoscopy organised and above sphincter in prostate apex, tissue had grown and blocked the channel like a curtain with two smallish holes in it. I'd say it was an 80% blockage. TURP procedure required to remove tissue. That was 2 days ago. I'm back home.

Despite being only 2 days post op, feels better already. The point here is that the surgeon's confidence (hope?) in a complication free procedure meant that I had to spend 3 months in discomfort while he issued scrips for antibiotics that did nothing and played 'wait and see'. My symptoms 6 weeks after surgery were probably enough to merit further investigation without me having to push.

My own (not a doctor) theory is that heavy bruising of the bladder neck (mentioned by surgeon) cause a swelling that caused retention 24 hours after original catheter removed. They couldn't get a normal sized catheter through the swollen tissue and had to scale down to a 3mm foley. Even that was hard to get in. This was left in place for 10 days (because of national holidays). I suspect this acted as a scaffold for the tissue to grow across the urethra. I think one hole was the original channel and the second hole was the catheter pushing a channel through sheets of newly forming tissue - possibly pushing a strand across to start the bridge. Trapped by the catheter and not moved by urine flow, the tissue grew.

The catheter came out and from that point the flow and discomfort just got worse as time passed and the tissue filled in the gap.

Unlike TURP which cauterises the urethral wall, aquablation leaves a rough, raw, living surface with a lot of 'candy floss' debris and ribbons of live tissue. Many surgeons use a TURP tool to clear out this debris surface and cauterise bleeds. I wonder if this difference in the nature of the surface left after surgery makes aquablation a bit more prone to these adhesions across the urethra?

Anyhow, two surgeries, lot of expense and frustration, plus a lost year of discomfort. Fingers crossed that this time, we are where we need to be. My point is that if your recovery is way off what is expected and you have clear symptoms, you may have to decide at what point you start to push for investigation to save yourself a very long wait for the surgeon to come to the conclusion that things have not gone as hoped.

Thank you for sharing your experience. They should have explored your problem much sooner. I have watched some procedures and using turp to clean out the fluffy debris aquablation creates is an important step. Even though much of aquablation is “automated” there are still skills physician’s must gain through experience. By sharing your story those of us who hope to have aquablation are better prepared to gauge how well we are recovering. We all need to be prepared to advocate forvourselves and speak up when our intuition is telling us something is just not right. I sincerely hope the rest of yourvrecovery goes smoothly.