Aquablation: Post-surgery expectations

I submitted my 5 week summary report, on my post Holep recovery, to the urologist.

Just has Aquaplation performed July 2026, I had prostrate over twice normal size and extremely restricted flow. Meds had marginal benefit. Surgery was easy but I was asleep. Woke up to no pain, except when urinating. Catheter was the very inconvenient but not painful. Went home after one night of observation. Urine clarity was improving and after a week it was removed. There was urination discomfort for a couple days due to the removing the catheter. In my third week since surgery, I don’t have any pain, drinking lots of fluids except alcohol, my urine is light red, clots occur about every other day. I went back to my normal activities with the expectation of urination every 2-3 hours. Would I have the procedure done again, absolutely. Only I wouldn’t wait so long to seek help.

@gjaculley Glad it went well. 9 days until mine. Hoping for a good outcome.

I had aquablation 8 months ago and post-surgery have had persistent anorgasmia. Have done bloodwork to rule out any hormonal issues that might have pre-dated surgery. Am wondering if anyone has experienced this and what treatments, if any, have worked or not.

i had my aquablation 3 month ago and am due for a followup necxt month where they will do a rectal ultrasound as part of the followup. 1 month prior to surgury i stopped peeing so the fact i can pee again is great. unfortunately, my flow is slow, it takes awhile to start, have lots of starts and stops and i have to do multiple pees, especially after i get up. has anyone here had these issues after 3 months and then it cleared up? i am trying to see if its just part of the healing process or if something else needs to be done. what confuses me is that i had a rezum 8 years ago and i peed like a racehorse immediately after it. thanks in advance.

Well today is my day. 9:00 am. i will let you know how it goes.

@albiet
Get a cystoscopy to find out why? I had Greenlight in 2012, which was “flavor of the month” at that time. It fixed the flow problem but the prostate, as expected grew back. It was triggering blood in the urine every time I was running, occasionally causing blood clots that blocked peeing. Had a cystoscopy 2 years ago after such a clot episode. So in June this year, exactly 8 weeks ago, I had Holep. Recovery has been textbook.

I stopped wearing Depends 2 weeks ago, and only wear one at bed time. Hopefully I will be free from them 24/7, soon. Random bladder squirts still occur but has been gradually abating over the last 8 weeks. Holep and Greenlight is like chalk and cheese. 2026 Holep is a giant step forward in 2026. Had my review appointment 2 days ago. Urologist said he is very happy with my textbook recovery, and uses my example in his teachings. I assume he is referring to his training of urologists in the use of Holep, which requires significant robotic surgery experience,

The old “gold standard” of prostate reduction surgery was TURP, a painful, barbaric old school method, taught in every basic medical degree around the world, Holep, Aquablation, Rezum, etc are non invasive “robotic surgery” where there is no incision or cuts into body to reduce prostate size. A super thin laser is inserted through the urethra (where urine flows out from bladder. Here is a googled explanation:

HoLEP (Holmium Laser Enucleation of the Prostate) is a minimally invasive laser procedure. It removes overgrown prostate tissue that blocks urine flow in men with BPH. A surgeon uses a scope through the urethra and a laser to cut out the exact block, then clears the tissue.

Absolutely NO pain. See attached below, I sent my urologist - tracking my recovery time line.

You must ASAP get a cystoscopy to find out obstruction to stream flow after initial improvement. The sooner you can find out why and take correction action. Blockages and restricted stream “damages” the bladder as it is forced to work over time in emptying bladder.

thank you for the suggestion and all the details. I plan to ask for the cystocopy and see if they can arrange for one.

Just wanted to add to the discussion for guys considering aquablation. It’s a great procedure. Highly recommend it.
However, if maintaining ejaculation is important to you, do not leave it to chance. Be sure at every appointment that you communicate that to every provider you see. Be sure they take you seriously. They can somewhat map the water jets accordingly. Not 100%, but should have better outcomes with this approach than not. There may be a trade off between maintaining ejaculation and removing offending tissue. Best wishes.

@psblin99 Well the 1st day is over. It was a long one. They were running behind so I was waiting. A few details I have not seen here on the blog. Prep included quite a few advance meds in the hospital. Reduce bleeding, reduce swelling, prevent infection etc. They even swabbed my nose with something like betadine to keep me from inhaling bacteria. Also got an IV med started one hour before the procedure.
Taking me to the OR time to wake up 65 minutes. Zero pain!!! Flushed me out for 3 hours, liquid in liquid out. Then sent me home. Wife had to go to the pharmacy for two meds. You may want to ask your doctor if he can send them in advance. More convenient. Also could have some more instructions on using the cath bags. Particularly emptying it. A little tricky.
Slept on a waterproof sheet but did not leak. Hung the bag on a stool below the bed. It was pretty full this morning so we emptied it. Had some breakfast and now just doing nothing until my appointment with the doc Monday.
Apprehension was absolutely the worst part so far. I will keep you posted.