Aquablation: Post-surgery expectations

Posted by Phil, Alumni Mentor @upstatephil, Jan 26, 2024

After decades of pills to (partially) manage BPH, I am scheduled for aquablation at Mayo JAX in mid-Feb. Has anyone had that procedure done? What was post-surgery like? What were your experiences regarding regular vs. retrograde ejaculation?

My expectations are high. My general health is good+ (71 yo), my prostate is enlarged but not massive, my PSA's suggest no cancer concerns. The surgeon expects a low-risk procedure (no incisions I believe) and a quick recovery (unless something unexpected pops up). I appreciate it's impossible to predict surgical outcomes with certainty - I would like to hear of others' experiences to help set my expectations.

Interested in more discussions like this? Go to the Men's Health Support Group.

Colleen Young, Connect Director | @colleenyoung | 1 day ago

In reply to @tiger14 "I have been following this board for a few weeks in anticipation of my aquablation procedure..." + (show)

@tiger14

I have been following this board for a few weeks in anticipation of my aquablation procedure on 10-15. It was really helpful to learn about the experiences of others. So, now that I’ve gone through it, for what it’s worth here is my story.

My procedure was a little different…I am part of a trial to use aquablation to both reduce the prostate and remove tumors. I had a biopsy in July that indicated two prostate tumors with the lowest possible Gleason score of 6 (3 +3). Initially the recommended treatment was aquablation for BPH (my prostate was about 80 grams) and surveillance for the cancer. But a genomic test indicated the cancer cells were aggressive and this trial was just beginning, so I hoped to be included to have a chance of removing the cancer, reducing my prostate, and having the best chance of normal function afterwards. I am 54 years old.

The surgery was done 10-15. It was basically the same as aquablation for BPH, except 95% of my prostate was removed (all but the capsule which is where the essential parts are located). The surgery was delayed about an hour because an instrument had broken, but once started it lasted about two hours. I was in the hospital one night afterwards.

At first there was no blood in the urine which surprised the nurses, but eventually it started. Through the catheter they washed out my bladder with saline all night, as others have reported.

I had an erection the very next morning, which was a pleasant surprise. I went home with the catheter for six days, which was not pleasant. I would have liked to have been more active, as I felt like I was physically able to the next day, but when I tried to walk the catheter pulled against the tip of my penis, which was very irritating and painful. I finally decided to just wait until it was taken out. It was frustrating to just sit around for that long, feeling like you could do a lot more. Being patient was maybe the hardest thing.

They removed the catheter this morning. It was maybe the greatest feeling of relief I have ever experienced. It came right out without any pain or discomfort, and I passed the voiding test with flying colors. My urine was still pretty red. I went by my office afterwards just to check in, but didn’t stay as I wanted to gauge my urinary function before spending a full day at work. I didn’t want to spend the day at the office peeing down my leg.

Not to worry. My urinary function is almost 100%. It’s a little difficult to hold it for a long time, it burns some to pee and there is still a little blood and tissue coming out, but not too much. The flow is much improved, it comes out like a firehose and then doesn’t last long because of the volume. When I’m done it shuts off immediately and doesn’t keep dribbling out like before. I wore a pad all day and there are traces of urine in it, but not much. I am very surprised.

I must say, so far so good. Tomorrow, one week after surgery, I plan to spend a full day at the office. Over the past couple of years, at least a half dozen times a day I’ve walked the length of our floor, about 100 yards one way, to go to the men’s room. I am very curious to see how that goes tomorrow.

The big test comes in December, with another PSA to see if the cancer is gone. But for now the relief of the BPH symptoms is much appreciated. I may sleep the night through tonight for the first time in years.

My restrictions are light activity for three weeks after surgery, i.e. no lifting of anything over 15 lbs, no pressure on the prostate region from cycling, riding a mower, golf cart, UTV, tractor or the like. Basically walking and other gentle low-impact exercise is okay. After that, the activity level is based on tolerance, with blood in the urine as the gauge for tolerance level. They said I can drink alcohol in moderation, but I think I will abstain for that three-week period.

As I was finishing up this post, my wife came over to see what I was doing. As a test, we messed around for a bit and I got an almost instant, full erection. I don’t think I’m quite ready to follow through on that, it’s still pretty sore down there, but it seems promising.

Sorry if any of this is TMI, but the reason I was interested in this board was to learn about such things. Inquiring minds want to know.

More to come as the weeks go by….

Jump to this post

@tiger14, welcome. I'm glad you ventured out from behind the screen so to speak to share your story so far. It helps for future inquiring minds, who may read before posting. 🙂

How are you doing now 2 weeks later? Any updates?

tiger14 | @tiger14 | 1 day ago

Hi Colleen,

In the spirit of no news being good news, I don’t have much to report. The recovery has been about as uneventful as it could possibly be. I stopped passing blood about a week ago. Everything is still working like it’s supposed to, except I am urinating much better than before. The velocity at first was startling, it comes out in a band that’s about half an inch wide or more, but now it’s just pleasing to be able to go like I did when I was a young man.

I have one more day of light duty, and then no more restrictions. I have not taken any medication to help with flow since a couple of days before the procedure. I occasionally still have some very faint burning when I go, but it’s hardly noticeable.

Without pushing it too hard, I started to resume some normal activities last weekend. I did some light things around the house, and had a couple of bourbons, without seeming to cause any harm. I also had my first orgasm, which seemed about the same as before. (I did it on my own….I needed a practice run to see what it was like before trying with my wife…that comes later this week, pun intended.) I was already experiencing RE from the meds….and that didn’t seem to change. I didn’t notice any blood or other discharge… it seemed to be just a dry heave. Other than that, it felt about the same as it always has, which was another pleasant surprise…I really didn’t know what to expect.

My follow-up PSA was moved up to November 20. Then I will know for sure if I’m completely out of the woods. As far as treating the BPH goes, so far it seems to have gone about as well as it could have. I’ve seen some comments expressing regret for having the aquablation procedure…my experience has been just the opposite. With hardly any trouble, it seems to have solved the BPH, and I’ll find out in a couple of weeks if it successfully treated the cancer too.

Stay tuned….

diverjer | @diverjer | 16 hours ago

CT is just to far from Kansas, glad things worked out for you. The reason I went with aquablation was I like the least intrusive method possible. That is also why I tried Urolift first which didn't work, then the aquablation which didn't work. They say I am 84 grams and I am 78 years old. I am getting by okay on flomax, but it could cause some compilations on upcoming cataract surgery. I been needing cataract surgery for 2 years now and had hoped I would be off flomax, but that isn't going to happen. Can't put it off any longer. Alpha-blockers like flomax relax the muscles in the bladder, prostate, and iris. During cataract surgery, the iris is dilated to provide a clear view of the lens. However, in patients taking alpha-blockers, the iris muscles may be too relaxed, causing it to become floppy and can cause problems.