Aquablation: Post-surgery expectations

Thank you..

All...update on my recent Aquablation surgery experience. Aquablation was originally scheduled for 4/15/24, but postponed to 4/29 due to a UTI that developed per urinalysis; I needed to run through a course of antibiotics before surgery. On 4/28, I developed excruciating pain from a hernia repair surgery (performed 2/13/24, the anesthetics from that surgery are what caused the complete prostate blockage, requiring prostate surgery). The hernia had somehow re-emerged around the mesh, after 2 1/2 months (!?) causing the mesh to bend, and the excruciating pain in my groin (I could not move, barely stand...I had to painfully make my way to the bed or floor to get the pain to cease). I did not tell my urologist about the hernia issue; the hernia pain was only evidenced when I moved my waist...twisting, bending, walking...not while lying down. As I lay in bed most of the time in the hospital, it thankfully, wasn't an issue. Aquablation surgery was successfully done on 4/29; I was in the hospital until the evening of 4/30. Sent home with a catheter. The urologist's original plan was to have the catheter removed on 5/9. After returning home from Aquablation on 4/30, the excruciating hernia pain was much worse and more often; thankfully my son was here to assist me. We went to ER 5/3 and CT scan showed the issue with the mesh. It also showed that another umbilical hernia had developed. So...had a second "double" (inguinal and umbilical) hernia surgery on 5/9, from which I'm still recovering without issue. The urologist then removed the catheter last Thursday 5/16. The hernia surgeon told me to postpone catheter removal at least a week due to my previous prostate/bladder issues with anesthesia. Halleluiah! I had had a catheter in place since 2/14...the day after the first hernia surgery! Over 3 months. I'm learning how to pee (and have BMs) again. Despite a couple of accidents, things seem to be coming together. I need to pee about every 1-2 hours it seems, but a strong, mostly painless stream. Have to get up 2-3 times in the night to pee. Won't be trying sex for a while.

IMPORTANT NOTE: After about a month with the catheter, it became more and more painful (pain at the end of my penis was caused by the catheter in my bladder per my urologist) to have a BM...the last week after the hernia surgery it was almost unbearable. Absolute agony for about 1-2 minutes after the BM until it ceased! That pain ceased immediately after the catheter was removed.

Hope this isn't too much info, but...bottom line: If you have BPH, and anesthesia affects your prostate/bladder severely like it did me, have prostate surgery well BEFORE you have to have any surgery with anesthesia again. As you never know when that might be...get it done sooner rather than later! Don't put it off as I did...or you might be with your unwelcome but necessary "friend", the catheter!

Ouch!!

Hi Phil. I am 64 and have had BPH since my late 40s. I find that tamsulosin just simply doesn’t work for me and it caused retrograde issues. Like you, I have been on a combination of tamsulosin and 5mg of cialis - and it still hasn’t solved the urination issues, but retrograde has mostly improved.
I have an appt at MayoJax on Tues for another Uroflow test - and I’m sure I will fail that again. I find that my BPH is worse in the mornings despite the medications, but that by mid-day my urine flow is better. I’m still getting up 2-3 times a night. With all the different surgical procedures, how did you decide on Aquablation? Is aquablation the same as Water Vapor Thermal Therapy? To complicate matters, I am a liver transplant patient, and I’m trying to get off of as much medication as possible, so I think it’s time to take action on the BPH. My brother had Holep , but his prostate was over 200g. I think mine is about 60g. I don’t want to end up with RE or other sexual side effects if at all possible. Would appreciate any advice you might have.

I am 60 and also have BPH issues (and prostate cancer that is Gleason 6, on active surveillance). My urologist did a cystoscopy to determine what was causing the blockage, and then set a treatment plan from that.

In my case, it was an enlarged median lobe. He recommended a partial TURP procedure to remove the median lobe rather than aquablation or HoLep of the whole prostate. He also does aquablation, but the reason he recommended partial TURP is because he felt that preserving as much of the prostate as possible now, and doing the least invasive treatment now, would better preserve cancer treatment options down the line if the cancer progressed. And would potentially reduce the risk of later complications like incontinence from the cancer treatment. He felt that more significant treatments like HoLep or Aquablation would definitely resolve the issue, but would make some prostate removal treatments later a bit more tricky. Doable, but tricky.

So, to get a second opinion I met with Mayo in Rochestor to discuss HoLep and they felt confident they could solve the BPH issue and weren't too concerned about the difficulties of treating cancer later. I then asked them whether they could come back and do HoLep after a partial TURP and they said no problem. So that was a plus. As a side note, I asked them if they could do a partial HoLep on just the median lobe and they could. A Mayo doctor in Jacksonville does this.

I then spoke with my urologist about it later. He said that yes that is possible, but didn't feel like that was necessary given the simpler approach of a partial TURP. Also, he mentioned that if he were to try and do a partial aquablation, it produces some rough edges and that he'd have to then go in and do some clean up with the TURP tool. In his mind, why do the partial HoLep when it's overkill and why do the aquablation when cleanup is needed anyway from the TURP tool. That's why he chose the TURP tool. I also got the impression from the Mayo doctor that he wasn't too excited about a partial HoLep procedure.

So, for me I liked the idea of potentially resolving the issue for several years (5+ hopefully, if not longer) with the least invasive treatment of just the median lobe. But to get to that decision, it all started with the cystoscopy.

@gerryp - Great questions. Let me work on answering them.

My prostate wasn't gigantic but more like yours in size. My principal objective was to reduce my daily medicine requirements - plus the tamsulosin/Cialis cocktail wasn't producing the desired "no bph symptoms" effect. I also wanted to eliminate RE if at all possible

I have been a urology outpatient of Mayo (JAX) since 2015. I also have other medical connections with Mayo - all super-successful in terms of outcome. So I trust what I hear from their medical teams.

During a regular urological exam in the Fall of 2023, they described they had begun planning to bring aquablation to the clinic early in 2024 and that the procedure might be worth my consideration. I went home, did some on-line research, then raised my hand to say, "Put me on the list!"

In very short order they called, I completed an on-line consult with the urologist/surgeon, and that very day we decided to go forward.

How did I decide on aquablation? Mostly, I relied on my built-up trust in Mayo. After doing some research online I decided the extremely low risks of aquablation balanced against my desire to reduce pill intake while eliminating all bph symptoms (my multi-pill-a-day regime didn't eliminate all symptoms) - It was an easy decision and I'm pleased with the result. I guess there might be other procedures that could have produced the same result...

It was my prior tamsulosin/Cialis cocktail that produced an RE side effect. I believe RE is a side effect of tamsulosin rather than a side effect of bph. I'm now 3 1/2 months post aquablation and there have been no sexual side effects while my previous RE has abated and continues to increase in volume. Orgasmic intensity is unaffected.

I still get up a few times a night to urinate - but way less than before aquablation. Urine flow is satisfyingly strong, bladder emptying is complete, and the "need to pee" has significantly declined in intensity.

Of course, my exact experience may not be yours if you undergo aquablation.

How else can I help?

Thank you so much Phil. I also very much trust Mayo Jax as they successfully transplanted me. I spent the last few hours researching & watching videos on the aquablation procedure and it does seem like the most effective treatment with high rate of success and saving ejaculatory function which is important to me. Tamsolosin has never worked for my symptoms but resulted in RE. The addition of cialis has resolved the RE somewhat, but the urinary problems persist. As a transplant patient, my medication options are limited. Prior to transplant I found alfuzosin was the most effective treatment without the RE side effects, but they won’t give it to me now as it interacts with my immunosuppressant drugs.
I have an appointment tomorrow for follow-up and will ask more questions. Last time I discussed this with my team in 2023 they recommended TURP, but my grandfather had that procedure multiple times and still had many problems, so I don’t want to go there.
Would you mind sharing the name of your surgeon?
I still need to understand the difference between ablation & enucleation with the holep. It seems like it’s the same thing - a removal of prostate tissue. Thanks for your willingness to share information. I too want to get off the drugs.

@gerryp - Dr. Chandler Dora. He was terrific.

Best of luck in your decision!

Dr Dora did my brothers holep. Appreciate the info. Here now and will ask lots of questions