Aquablation Experience 03/23/23

Men's health
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Thought that I’d share my Aquablation experience for those who might be interested. (Warning…long & detailed post, per requests to me)!

I just turned 63, I’m relatively fit/active (but truth be told that I’m more of a weekend warrior than a dedicated fitness individual). Luckily, I have no diabetes, cardiac issues, nor other comorbidities, but have suffered with BPH for about 12 years now.

I’ve been on BPH meds for about 11 years, starting with Tamsulosin. Due to undesired side effects, I switched over to Alfuzosin early on, but that only helped moderately, due to my having an enlarged median lobe.

My prostate was 71.4 cc (this morning, but it’s much smaller now!). Over the past 11 years, my PSA has only increased (linearly) from 0.4 to 1.3., and a cystoscopy from a few weeks ago showed no strictures/scarring/lesions/stones nor issues other than my significantly enlarged median lobe and mild/moderate trabeculations.

Although I was very close to full retention on a number of occasions, I luckily always managed to squeak on by, and had never needed a catheter (until post-op today, as I’m currently being irrigated with a 22Fr 3 way catheter).

I arrived at the hospital (in Philadelphia, Pennsylvania, USA) at 5:30 this morning, was brought into the OR at 7:30AM, was transferred to Recovery at 9:00AM, and was in my room by 10:30AM.

The only “pain” that I’m experiencing today is at the tip of my urethra, where the Foley exits. I did, however, have some persistent bladder spasms which were not painful, but were quite annoying/ discomforting as I continuously felt like I really had to urinate (even though my bladder was “empty”, as it was draining into the bags). The nurses resolved most of my pain & discomfort with a combination of Lidocaine gel at the tip, and a script of Oxybutynin (for the bladder spasms). I was administered a few Extra Strength Tylenol tablets (acetaminophen) , in addition.
I have NOT yet experienced any internal “prostate” pain, nor testicular pain, but I only just had the surgery ~10 hours ago today.

My surgeon was just in to follow up with me, and explained that she spent significant time mapping the procedure (to try her best to balance flow concerns and to address my specific desire to try to maintain full functionality if possible) and that she performed 2 passes of the Aquablation, followed up by ~15 minutes of “fluffy tissue cleanup” and electrocautery. She felt that all went “textbook” well.

I’m pleased that I’m already seeing a significant clearing of the irrigation fluid (with an occasional small clot).

My biggest concern is the catheter removal and void test that is planned for tomorrow. Some on the boards have mentioned that the removal is relatively quick and painless while others have expressed that it’s quite “unpleasant” (yes, even with the Foley balloon fully deflated). I’m also expecting the urination to sting/burn, but we’ll see how bad it is

I’m confident that in a couple of months I’ll have “no regrets” that I had the Aquablation done, and will have a significantly improved quality of life.

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Jonathan hope you are doing well in you first day post aquablation. Thanks for sharing you insight. Hope you continue to improve and keep us updated on your progress.

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Day 2... Still at the hospital this morning, I woke up tired (due to typical hospital "poking and prodding and taking of vitals" through the night), but feeling well, and having a surprising lack of discomfort. I was still being irrigated, and was passing some small clots through the Foley (quite typical). They next disconnected the irrigation, and saw that I was continuing to pass urine with small clots (with the Foley still in place). Before they removed the catheter (as was planned), I expressed concerns to the physician's assistants about the possibility of clots clogging my urethra (and causing retention and and ER visit) over the weekend, and they explained that I could keep the catheter in over the weekend if I desired, and I opted for this instead. I now have the catheter removal and voiding test scheduled for this coming Monday morning.

Overnight, I had a bit of bleeding had that had passed between the outside of the catheter and the inside of my urethra making a bit of a "sticky mess" at the tip. I was permitted to walk to my room's shower and carefully get myself cleaned up. It felt really good to be clean again. My only discomfort was at the tip, where the catheter was moving around a bit. A good tape patch was then used to hold it in place, and discomfort is now quite minimal.

My meds were reviewed, and for now, they're keeping me on my Alfuzosin, and have me on a ~ two week Ibuprofen/Tylenol regimen, as well as adding Senna stool softener. I was instructed to drink 8-10 glasses of water a day, to not lift more than 10 lbs., and to “abstain” for 6 weeks. I was released after lunch, and was even allowed to walk from my room, through the halls, and out to the sidewalk to the car. I was amazed that I was feeling this good just a little over 24 hours of the operation.

I'm now writing this post from my recliner, in the comfort of my home, still amazed that I had the procedure just yesterday morning. The liquid in my catheter bag is a light tea color (darker than the watermelon color that it was when I was still being irrigated). Presently, it is without clots.

Truth be told, I'm still a bit apprehensive about the catheter removal, and of potential level of discomfort upon urination, but in the mean time, I'm looking forward to a relaxing weekend, and will report back on Monday.

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Thank you, Randy.

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Can you hold your pee after the catheter removal (urinary incontinence)?

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Hi Compiler, I can't yet answer that question, as "we" opted to keep the catheter in over the weekend. I'm now scheduled to have it removed this Monday morning, and will try to respond/ post after that.

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This morning, I had my post-surgical 3 way 22F Foley catheter removed, and had a post-void test. While looking forward to getting it out (waking up “aroused” with a catheter in place is less than pleasant), I was still a bit apprehensive about potential discomfort of the catheter being removed, and asked the Urology nurse to let me honestly know when she was going to remove it, and to slide it out gently rather than to do any tricks such as to say “ I'll remove it on 3 count” and then to actually yank it out at “2”. Thankfully, she complied, and was very gentle.

She first put 200 ml of sterile saline into my bladder (via the catheter), then carefully deflated the Foley's balloon, and with her gentle pull, it slid right out. Discomfort /pain level was honestly only about a 2 on a scale of 10, and only lasted for less than 5 seconds. Phew!

I was given a 1000ml urinal bottle and a drinking cup, and told to drink water and come back (“in about 4 hours”), when I had filled the urinal for her. I was concerned about potential incontinence, but my concerns were unfounded. I left the office, went down to the waiting area, drank a cup of water, and a few minutes later went to the men's room, and was easily able to initiate flow into the urinal bottle. I had complete control of my stream, only had a small tinge of pink, and the discomfort was negligible (maybe a 1 out of 10 at the most). I went back to the waiting area, drank more, and repeated the process until the bottle was full. For me, this was only a 2 hour mostly comfortable process, and I felt like Pinocchio (“I can pee like a REAL boy now”!).

I brought the bottle back, had to wait about 5 minutes for the nurse, and she was very pleased to see both the short time that it took me to fill it and the content's relatively light color (just a tinge of pink). My residual (via the ultrasound) was 128ml, and the nurse expressed that she had hoped for less. I expressed that it had been more than 5 minutes since I had last voided, and that I felt that I could now easily void more. She handed me an empty urinal bottle, showed me to the local restroom, and less than a minute later I was back to her with a bottle with more than 100 additional ml in it. She was quite pleased to see the then “only ~30ml” PVR.

Gentlemen, it's hard for me to even begin to fathom that just less that 100 hours before this, I was in only in PRE-OP for my Aquablation procedure, was close to being in retention, but now had no incontinence, had complete control over initiating and stopping my flow, flowed “like a 20 year old”, and had only negligible discomfort. (Note that yesterday, I had experienced some mild bladder spasms, was told that they should stop when the Foley was removed, and they did indeed almost immediately resolve themselves).

Writing this now (a few hours post my above experience from this morning), I have continued to be able to have complete (and pain free) voiding, with only a small clot/tinge of color at the start, but with a HUGE smile on my face, and admittedly tears of joy in my eyes that I can now easily do in 5 seconds what just last week (and for the last 5+ years) I had to struggle for more than 15 minutes to do.

I realize that we all heal differently, that this is only my first catheter-free post-surgical day, that during healing things may take a step backwards, and that it's FAR to early to know if I'll have RE, but oh my...I can only wish that others of you can be as “fortunate” as me to have this easy and seemingly successful time of it.

Best wishes to all for an easy procedure and to a successful recovery.

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Excellent update. So glad to hear all the positive results. Hope it all continues to get better each day.

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Hi Randy, Thank you very much for your kind words and sentiments!

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If you are comfortable sharing....was your surgeon Dr Lloyd Harris at Penn? How many had she done before yours? Did she warn of potential retrograde ejack (and did it concern you)? Thanks

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Thank you for your posts and updates. Best wishes for a speedy full recovery with little to no pain. I am two weeks out from aquablation (full retention here, been using intermittent self-catheterization for 2 months) surgery, and your posts have been very informative and helpful.

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Hi lowflow,

Yes, Dr. JLH at Penn...She was GREAT, and I'd recommend her in a heartbeat. She said that the Penn team had done 40 something AB's now, but I didn't get a specific #. I know that both she and Dr. William Jaffe at Penn have been doing AB's for a little over a year now.

She did warn of a potential of RE, but felt that I had a really good chance of maintaining full functionality due to a large portion of my particular issue being an enlarged median lobe, which is a distance from the EJ ducts.

She listened well to my prior expression of concerns of efforts to map to balance flow and maintain "functionality", and even reiterated them to me (before I could re-stress it to her) while chatting with me in pre-op, minutes before the procedure.

If you are considering using her, please feel free to reach out to me via Message, so that I can share more about my positive experience with her/Penn. - Jonathan

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Hi Joel,

Thank you for your kind words, and sorry to hear that you're suffering from full retention. While you've had to go through the inconvenience/discomfort of self cathing, I'm hopeful that the experience will serve to minimize potential apprehension of your upcoming procedure.

I'm hopeful for you that your experience and healing will be as quick and uneventful as mine, and should you care to reach out to me separately via Message, please feel free to do so. - Jonathan

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Hi All,

A relatively quick update today...

Last night (Monday night) was my first night without a catheter (since my Aquablation procedure on Thursday morning). I went to sleep a little after midnight, not quite sure what to expect, and how things might go... I woke up at 2:37 AM with a moderate urge to go (all was dry in bed), I went over to the toilet, effortlessly voided (not even a hint of pink!), and crawled back into bed...The digital clock still showed it still being 2:37...It felt like a dream, as prior to my Aquablation, I would have been half asleep on the toilet straining to void for more than 15 minutes, and have then spent another more than half hour trying to fall back to sleep with a heavily disrupted sleep cycle. A parallel event occurred at 5:45 AM (but this time the clock showed 5:46 upon my return to bed). I was truly elated.

I woke up at 7:30 this morning so very well rested, and relieved of the anxiety of what to expect. I must however honestly state that when I woke up, it was with a slight discomfort (a slight stinging of my urethra), as my "member" seemed to be quite fully awake too. I guess that it needs just a little more time to heal from the catheter, and I'm planning on abstaining for the full 6 weeks as suggested by my Urologist/Surgeon.

Gent's, I realize (and am greatly appreciative) that I appear to be one of the luckier ones here, and must reiterate that I'm only 63, relatively fit, and have no diabetes/other comorbidities , and typically heal quickly. That being said, It's still hard for me to fathom that I only had the procedure ~125 hours ago. I can honestly state that other than this morning's very mild stinging when I awoke fully aroused, "If I didn't know that I had just had the procedure this prior Thursday morning, I wouldn't know that I ever had (or needed) the procedure" . I realize that I'm only 5 days into it, but it has been truly miraculous for me, and I can only wish similar (easy and effective) experiences for the others of you that are going through this. - Jonathan

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Hi Jonathan. Thanks for the reply and your most recent update. Great to hear you are doing so well. Your progress is an inspiration for me and others. I'm hopeful for the same. 68, fit, live a very healthy lifestyle, take no medication, no comorbidities. Total obstruction, but my urologist believes Aquablation will successful for me, my cystoscopy indicated medium trabeculation. I've never been a patient in a hospital and am somewhat anxious about the procedure and hospital stay. Your updates are really helping me. Thanks again.

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Thanks -I will reach out as I get closer to decision time. Dr Steven Sterious in Langhorne (Temple system I think) also apparently has done them prior to Penn starting up their equipment. His on line reviews were not stellar)

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Hi Joel, Thank you for your kind words.

I was quite anxious too (even about just going for the cystoscopy), and can imagine some of what you might be feeling.

Please feel free to reach out to me via Message if you'd like more details/to correspond privately.

Hoping that things go smoothly and easily for you.

  • Jonathan
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Hi Jonathan It's great to read all your successful journey with Aquablation. I'm 11 days away from my Aquablation procedure. I just turned 66 and pretty fit and healthy. I am pre-diabetic and Vit D deficient at times and low potassium at times. Pre urinary retention I was working out daily and running 5k's. I can't wait to get back to that and planning our retirement travels we cancelled during covid.

I have had my catheter in for 6 months now, during I've had another trip(blockage in catheter) to the ER for retention and 3 UTI resolved by antibiotics. My delay had mostly been appealing my insurance Kaiser Permanente to refer me outside cause they don't offer Aquablation in Calif yet. Rumor is at the end of this year they are going to have first Aquablation done before going wide spread. I am Medicare also and surprised they didn't assist in any way. I should have only appealed once but really thought they would help. Finally I dis enrolled Sept 1rst from Kaiser and now Medicare with Blue Cross Anthem. Medicare 80% and Anthem the remaining 20%.

My urologist is 2.5 hours away in San Carlos , Ca and will do the procedure at Sequoia Hosp in RedWood City, Ca. I have family in the area we will be staying with so that's going to workout great.

It looks like you're almost 6 months post opp. How is everything now? Any retrograde or incontinence ? Like you those were my big concerns. Specially the incontinence if I had to pick one over the other.

Thanks for sharing a well a wonderful and well informed post about your experience. Mike