Aquablation: Post-surgery expectations

I, too, had PAE done (past July) for BPH. 63 yo/large prostate. I stopped taking finasteride in August, as there were libido and ED issues that I wanted to see if getting off the finasteride would make a difference. It seems my BPH symptoms are still present. I also have a 3+3 PCa (in on core of the first of three biopisies -- no other PCa found as of yet). I'm interested in exploring aquablation. Maybe I should give the PAE more time. Taking 10 mg/daily of tadafil, per urologist's recommendations.

@dfwcraig thank you for sharing. Glad it is going well. 👍

I had my Aquablation done on Dec. 18, 2025. I'm 75 and otherwise in good health. My experience has been less than stellar: they let me go home the same day. On the 2nd day, I was in such pain that my wife had to take me to the emergency room. On the 2nd day, all was going well, still had my catheter on, and the next morning I woke up with an empty bag. Whoops. Back to the emergency. This time, since I was supposed to have the catheter removed the next day, they removed it.

Somewhere during all this, I started with hiccups, which, after 3-1/2 days, got to be old. (Yeah, it reads funny, but it really isn't. The first night was hard to sleep. The next night, I was able to sleep, but my wife said my snoring woke her, and I was hiccupping between snores. Back to my hospital (but not emergency this time), I went on a different anti-acid drug that seems to be working.

Meanwhile, I kept on telling anyone who'd listen to me that the pain on urination was very bad. The kind of bad where you could not talk in any way. Finally, one PA said I should have my urine tested. It was, and I did have a UTI. Now I'm on antibiotics and have one more day of that. Pain has gone down dramatically.

The pain is now minimal, probably what I should be having after the treatment, and I've not seen any blood in about a week. My main issue is that if I have go, there are times when I HAVE TO GO NOW!!. I'm wearing pads, but I don't think they can catch it all if it comes to that. I've only had one pre-spill, and it was fortunately caught.

Now it's just over four weeks, and I'm hoping to start doing more things. I'm delighted to have found this group, and I thank Mayo for having it. I've been wanting an experienced group to talk about this. My hospital doesn't have anything like this. (Kaiser Permanente in Southern California. If anyone has any words of advice for me, Please do.

@garysc Im glad you are improving. Many men experience increased urgency issues after AQ that usually improve with time. There is medication you can take to reduce these spasms. My doc sent me home with some but i havent used them.

UPDATE!

I am now about 10 weeks after Aquablation (Nov 4, 2025). This has been a journey. Five visits to the ER and one to urgent care.

My symptoms are finally getting better. The burning has diminished quite a bit. I am still experiencing the need to do #2 after urinating, but the feeling has decreased as well. Frequency is less and urgency is manageable. The bladder spams are less intense and controllable. I have been holding urinating for a second when at the bathroom. This helps me with strengthening my pelvic muscles. One aspect that has been weird are my ejaculations. I did not test the pipes for almost 5 weeks. The first few times force and volume were better than before the procedure. Now, the force and volume are less. This could be due to many factors like stress, lack of sleep, etc. I do not believe is retroejaculation since it was plentiful at first. I should get better, not worse.

My advice for people reading my post and going through issues:

1. Have emotional and physical support. This aspect is very important for recuperation. I live by myself, and has been brutal for me.

2. Stay positive. Recuperation varies, most of us go throught similar symptoms. The difference is how long it takes to get better.

3. Post op care is the most important. My doctor has lacked in this area. No follow up instructions, what to expect, what are the things to watch for, etc. This procedure still fairly new and there is not a standard for post op care.

4. Stay engage in places like here. This forum has been a lifesaver. I have read people experiences and made me realize that I was not alone.

I have a follow up next week with my Urologist (my own request). I will ask to perform an ultrasound and an abdomen MRI. This is my health! I am an active participant of my care. Questions like why the feeling the need to defecate after urinating, when can I start riding my bike, lifting weights and do kegel exercises. As you can see these were not addressed.

Stay strong!

@connect4321 I did get some of the spasm control. Two, in fact. One left me dizzy and a bit loopy. I stopped those immediately. The second one, mirabegron, does do that, but after two weeks any help is so insignificant that I cannot look you in the face and say it’s helping. I was told by the pharmacist that it could take two weeks to take effect, and it’s past that now. Ah well, in another week I’ll be seeing the doctor and we can talk about it. Thanks for the thoughts.

Just had mine 10 days ago, and I'm very pleased so far. My prostate choked off my urethra at the end of June '25, and I had to wear a Foley for 6 months. They attempted the usual meds (we knew that wasn't going to work), I had the cystoscopy and then the biopsy to rule out cancer. I dove into the research online and found the aquablation myself before the doc gave me my options (after the biopsy). I already knew which procedure I was going with, I'm a young 65 and want a healthy sex life moving forward, and the aqua gives the best chance of that. Plus I wasn't keen on getting sliced up. Day of the procedure, I was knocked out on the way to the ER, and woke up a few hours later in recovery. Doc had me stay 1 night as a precaution. Left the next day. The first 24-48 hours I wore depends, because there was no lead time to my brain getting the message that "we have to pee" - the urge and flow hit almost simultaneously. Once my body and brain got in synch, I'd have enough time to get to the bathroom, by day 3 I was in complete control. Had some blood clots trickle out the first 48 hours, nothing major. After the 72, it's been fine - I am urinating more frequently than I used to, but it hasn't even been 2 weeks, not making any snap decisions. Doc gave me stool softener (colace) along with other meds, I have been a little constipated. That's partly my fault, I'm not very diligent about drinking water. Never have been my whole life, old habit. There's no pain, and I'm sleeping pretty well through the night.

@understandingsquare
Glad your recovery is going well. I took that stool softener and was glad I did. Still, my first BM didnt happen until six days post. Anesthesia now often has fentynol and oxy and they cause constipation.

Back to post surgery expectations, I have two for you: I had my surgery five weeks ago, and I'm still "suffering" two issues: 1) there are often times when I feel like I need to pee and little comes out, but at the end of the urination, it is very painful. If I do have a full bladder, there is little, if any, pain. Has anyone else experienced this? Did it get better over time?

2) I am still having situations where if I'm sitting and feel like I need to pee, if I get up and do not go straight to the toilet, I am likely to have to make an emergency run to the toilet. (Watch out, anyone in the way!). So far, I've only had one bit of seepage, but the fact that this happens makes me concerned about spending a day out without immediate access to a toilet. Again, if anyone else had this, does it get better over time?

Thanks for any comments and/or suggestions.