Aquablation recovery progress

Men's health
1

Hello Everyone - I am taking the suggestion posted on Ihsan’s discussion regarding aquablation, that all of us who have experienced aquablation should start separate discussions to report on our respective recoveries. I agree it will make our reports easier to follow.

I have posted about eight reports on Ihsan’s discussion. To summarize, I had aquablation on December 15th, which was approximately seven weeks ago. In short, I feel great now. I am enjoying perfect urinary function. The stream is powerful, I have total control, I have plenty of warning, and trips to the bathroom are spaced a reasonable three or so hours apart. I can sometimes hold out longer if necessary, but the doc says I should try to urinate at least every three hours during the day. I wake up only once per night, which is a huge improvement, and when I use the bathroom during the night, I have no difficulty emptying my bladder at all. Sex is totally back to normal, with full function restored. I may not have much more news to report going forward, as I think I have this procedure in the rear-view mirror at this point.

If you read any of my earlier posts, you would have noticed that I did have difficulty with the recovery symptoms. I was impatient, no doubt, and I was not adequately prepared or informed about what to expect. On further reflection, I fault myself for not asking more pointed questions and for not insisting upon a detailed explanation of what to expect in the recovery process. But we can’t go backwards, and at this point I am looking forward to a healthy future. I am really pleased with the results of my aquablation, and I would recommend this procedure for anyone suffering from BPH. However, I do caution guys considering this procedure that the recovery can be tough in the first few weeks, and you need to prepare yourself for the recovery process. You will need to allow for a few weeks off of work, be mentally prepared to be incontinent for a period of time, and be prepared to experience some discomfort. In addition to the incontinence and bloody urine, I also experienced several weeks of constipation, painful erections, and sharp pain in my urethra. I experienced a bout of depression during the recovery phase, partly because I was worried about what my future was going to be like. I also got some kind of infection that caused testicular pain. Other than the testicular pain, the pain was not severe most of the time, but I really did not feel great for about three or four weeks.

The good news is that, after I got over the hump, I started to feel terrific. BPH had been causing a major disruption in my life, and that seems to be behind me. I feel almost euphoric being able to control my bladder so well, which I haven’t been able to do in years.

If anyone wants to reach out with any questions, please feel free. I go back to my urologist in early April, and I will definitely post an update then. I will also post any significant updates, but for now I would say that everything is great.

Good luck to all - Ed

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Congratulations, Ed. Marvelous turnaround of events.

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Well Done Ed and thanks for sharing your experience and advices thereafter. Yours was among the posts that have helped me prepare for my procedure. So Ed, when did you finally return to work. And during your first and second week, what was the frequency like day and night, and how many litres of water were you drinking per day. It is my first week and am drinking between 3 and 4 litres to flush the blood. Not sure if this is too much or not enough as the nurses only say drink plenty of water to flush in the first week. Did you take other beverages like tea or coffee during this first 2 weeks?

Did you continue with your BPH medication (tamsulosin) after surgery? Thanks

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3 litres of water is not too much, just don't force yourself to drink when you're not thirsty. Even now, 2 years after my TURP, I think about 3L of water each day during work just to keep hydrated and also because I like knowing that I can urinate just fine now. :-)

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*I meant to say "I drink about 3L..."

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Hi James - I am self-employed, so I can be flexible about my schedule. I returned to work, more or less regular hours, on Jan 3, which was almost three weeks after the surgery (Dec 15). But I took it pretty slow for about the first week back.

I really don't remember how much water I drank each week, but I know I was trying to drink more water than usual, like you to flush the blood. I would say I was drinking about 3L per day, maybe 4L, plus at least two cups of coffee every morning. (I get headaches if I don't get my daily fix of coffee.) After a few days post-surgery, I was also constipated, so that was another reason to pump water. Also prune juice (yuck). I have continued consuming about 3L per day of water, plus 2 cups of coffee and occasionally milk or juice in smaller amounts. At this point, I am no longer concerned about urination problems, so I just drink what I want. At the early stages, I would say you're doing it just about right, with the caveat that you should probably stop drinking anything a few hours before bed. (I felt like a toddler being told that, but I actually needed to be reminded.)

For the first two weeks or so, I noticed gradually improving urine flow, increased warning, and decreased frequency. I'd say it was late in the third week that I realized that I was only urinating about every 2-3 hours, and sometimes needing to remind myself to do that. (I was told to be sure to empty the bladder by the end of three hours during the day, to avoid stretching it and risking infection.) Also it was late in the third week that I noticed the color of the urine stream start to lighten to a pink shade, then eventually return to a normal pale yellow. That was also about the time the scabs started to appear in the urine flow. The scabs can hurt when you're passing them - I hope you get some Azo on hand for those days.

I had stopped tamsulosin / Flowmax years ago. I found that it made me very dizzy, to the point that I could not function during the day. I also hated the RE side effect. I have been on a daily low dose Cialis pill (5mg) for about 4-5 years now. It hasn't provided BPH relief in a long time, and I'm thinking it's useless. (Cialis for ED is a much higher dose - 20 mg and up.) I was surprised when my uro said to stay on it until I see him again in April. So I'm still on it, but not sure why. I'd just as soon stop taking it.

Keep us informed as you progress. It sounds like you're on the path to recovery. I regretted that I had this procedure for the first couple weeks, but now I'm thinking it was the best thing I ever did for myself. I'm enjoying a complete turnaround in BPH symptoms, with no adverse side effects. That's a win!

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Thank you for always being helpful Ed.

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I'm 58 years old and have experienced moderate BPH symptoms for many years. Ive also had prostatitis about twice a year for about the past 15 years. I was referred to a urologist who thinks I should have aquablation to solve my prostatitus problem. He thinks the prostatitis is caused by urine reflux in my prostate due to high bladder pressure and urinary obstruction. I have an appointment in about five weeks to have a urine flow/bladder pressure/PVR test, transrectal ultrasound to measure my prostate and a cystoscopy to look into the prostate.

I've been studying up on the procedure and I'm pretty certain that if the diagnostic tests indicate aquablation would be appropriate I'm going to go ahead with it. I would really like to get rid of the chronic prostatitus as well as the BPH symptoms.

My biggest concern is ejaculation after the procedure. Do you notice any difference in ejaculation like how it feels or semen volume? I would imagine that if a large portion of your prostate is removed it must reduce semen volume but that's not talked about much.

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Hi Blair - Thanks for reaching out. It has now been almost three months since my aquablation, which was done on Dec. 15th. From the outset, I have been concerned about preserving ejaculatory function. (I'm certainly not hoping to have more children, but I hated the retrograde ejaculation side effect that many of the BPH drugs caused.)

Since the procedure, I have noticed a slight decrease in semen volume, but the decrease has been negligible. I also notice that the semen seems to be a little more watery than it was before the procedure. The emission of semen also seems to be a little bit less forceful, but again only a little bit. So, I must admit that there has been a slight decline in my ejaculatory function, but the good news is that everything still works. I still ejaculate semen, but just a little less than before.

I should also admit that I've been a busy guy since I started having sex again after the procedure. I was told by my urologist not to have sex at all for six weeks after the procedure (not sure why that long). Since I got back in the game about six weeks ago, I've been sexually active almost every day. If I took a couple days off in a row, the volume and intensity of the ejaculations might well improve.

I do think this slight decrease in ejaculatory function is at least partly attributable to the aquablation procedure, but I am also 66 years old. I hate to admit it, but things may be winding down a little bit because of my age.

On balance, I would recommend the aquablation procedure. For me, the dramatic improvement in urinary function is well worth the trade-off for slightly decreased ejaculatory function. That's a personal decision every guy needs to make for himself.

I hope that's helpful. Feel free to reach out again if I can help - - Ed

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Thanks for your reply. I am very sexually active as well, at least four to five times per week. I also ejaculate a large volume. I've been taking the high dose of flowmax for several years and I haven't really noticed any difference in ejaculation. Even if sex is only a few hours apart I still put out a lot.

I've been trying to pay attention to what I feel during ejaculation and I have to admit that most of the time I don't really feel the semen coming out. Sometimes I wonder if I even ejaculated but then when I pull out there's semen all over so i know it happened. When I was younger I used to be really tuned in to the feeling of ejaculation and I could count the number of squirts. Now my orgasms are much more powerful than they used to be and the overwhelming feeling of orgasm overpowers the feeling of ejaculation. I don't know if flowmax has had any affect on this or not.

I would expect that semen volume would decrease after aquablation simply due to the fact that so much prostate tissue is removed. I think I'd be okay with less ejaculation volume if the pleasure was not affected and semen was still being ejaculated. I'd say that my semen is already watery. It's kind of grey and has a slippery consistency. It's a lot like Astroglide lubricant.

How would you rate overall sexual pleasure and satisfaction now as compared to before the procedure?

I've read online doctor recommendations to avoid sex for one to two weeks. I wonder why your doctor recommended six weeks. That's something I will certainly be asking my doctor about. I think I'd go crazy with no sex for six weeks. I've had sex at least every other day or more for at least the past fifteen years.

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Hi - I'm glad to hear you have a healthy sex life, and I can understand why it is important to you to maintain that as much as possible. My experience is that, after almost two months post procedure, my sexual enjoyment is exactly the same as it was before the procedure. My ejaculation is a little less volume, a little less forceful, and a little more watery. But the orgasm still feels about the same - it feels great!

I'm also a little older than you, and I think I may be slowing down a little due to age. It happens to the best of us. I had more forceful orgasms when I was younger, and I could squirt multiple times per day, sometimes huge amounts. That had already dwindled a little by the time I had the procedure. I'm not the tiger I used to be, but I don't think that's the result of the aquablation, at least not entirely.

I'm surprised to learn that Flowmax didn't have much effect on your ejaculation - it turned my orgasms almost completely dry. I hated that, and I stopped taking it for just that reason. Just because the Flowmax didn't make your orgasms dry, it does not necessarily follow that aquablation will not have an effect on your ejaculatory function, and you are correct to be concerned. What has your uro said about this? Mine all but guaranteed that I would still be ejaculating after the procedure, and that was the main reason I chose aquablation over other options. He was right.

I really don't know how much of the prostate gets removed in aquablation. I intend to ask my uro that question, next time I see him in April. It is clear that he left enough of the prostate behind to enable it to continue producing and expelling semen.

As for the mandated six week dry spell, you are right. I did go crazy! I followed the uro's advice to the letter of the law, because it was very important to me to maintain sexual function. So I didn't even touch myself for six full weeks. Toward the end of that period, I was like a horny teenager, getting erections for no reason in the middle of the day, barely able to control myself. I will say that when I got back to business, it was a little shaky at first. The orgasms felt weak, the semen seemed to ooze out instead of squirting, and it just wasn't as great a feeling as before. Initially I was really despondent about it, thinking that things had really changed for the worse. I am wondering now whether the six weeks on the sidelines hurt more than they helped.

After I got active again, I had about a week of sex only every third day (instead of almost every day). Eventually, I felt more or less normal again. I'm pleased to report that I'm now enjoying sex as much as I ever did, and almost every day. A couple of times, I've had sex more than once in the same day, and I ejaculated each time.

Next time I see the uro, I am also going to ask him why I got six weeks in the penalty box after the operation. Now that it's over, and everything worked out fine, I guess it doesn't make much difference. But maybe there was something peculiar about my anatomy that caused him to be concerned. If so, I'd like to know what that was all about. I may report the result of that discussion on here.

Good luck and let me know how you make out. - Ed

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Thank you for your encouraging reply. I'm glad it has worked out well for you. I've only seen the urologist once. He told me that he things I need something done and gave me pamphlets on aquablation, urolift and rezum. He briefly described each and recommended aquablation telling me the statistics on side effects but we didn't discuss anything in detail and I didn't know what to ask. As I've been learning about aquablation I've been making a list of questions to ask on my next visit. My next appointment isn't for another month. At that time he will do a transrectal ultrasound to measure my prostate, a cyctoscopy to view my urethra and prostate and a urodynamics test to measure streamflow, bladder pressure and PVR. At that point we will have a clearer picture of what needs to be done. Assuming the tests indicate that its appropriate and I'm satisfied with the answers he gives to my questions, I want to be able to go ahead and schedule the procedure at that time so I can get it over with as soon as possible.

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Hello Everyone - I'm about four months post-procedure now, and I had my last aquablation-related appointment with my urologist yesterday. I had my PSA tested about a week before - 2.0. That number is down from 7.2 shortly before the procedure, and 6.3 about a year before that. I'm really surprised by the dramatic decrease, but obviously that is great news. My uro said that the decrease is to be expected following the removal of prostate tissue.

My post void residual volume was down to 16cc. Another remarkable improvement in the statistics.

More importantly, I am still feeling great. My urinary function is exactly what any functioning adult would hope for. I urinate about every 2-3 hours during the day, depending upon liquid intake. I have no urgency or control issues, and my urine stream is strong. I always feel like my bladder empties completely. I still wake up to urinate once or twice per night, at least 3-4 hours apart. When I get up, I produce a strong stream with no difficulty emptying my bladder. I am not experiencing any sexual side effects from the procedure. I am able to achieve erections easily, and I am still ejaculating as before.

For me, this procedure has been a complete success. I am glad I went through with it, and glad to have it behind me. I have to say that my doctor did a great job, despite our communication issues about the recovery. (The recovery was a little rougher and longer than I had expected, but it was certainly not insurmountable.) My next uro appointment is not for another year, just to continue monitoring PSA and other symptoms (which I hope do not come back).

Good luck to all.

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So glad it all worked out for you and this is excellent timing as I have an appointment in about 2 hours to HOPEFULLY finally get my aquablation scheduled. These success stories definitely make the decision of which procedure to pursue a lot easier.

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Good luck, Randy. I consider my aquablation to be a major success, and I hope you have the same or similar result. Just be patient with the recovery. I think a lot of us on here have experienced that the medical establishment, as well as Procept, the company that developed and promotes the technique, tend to minimize the recovery experience. The negative symptoms are temporary, and not particularly painful, but they are challenging for other reasons. Just suck it up and realize that bleeding, tolerable pain, and temporary incontinence are to be expected, but that those symptoms do pass. After you're over the hump, you'll probably feel great. Let us know how you make out - Ed

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Hi Ed,

Did your urologist tell you whether the six week waiting period before resumption of sexual activity after Aquablation is just your urologist's routine instructions for all types of prostate surgeries?

It seems that various urologists recommend no sexual activity after prostate surgery for (variously) 1, 2, 3, 4, 5, 6, 7 or 8 weeks.

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Hi Von - I believe the six week waiting period is/was my urologist's standard instructions for all aquablation surgeries. I do not know if he recommends the same for other types of prostate surgeries. For me I think it was about the right period of time to wait, although it seemed too long when I was going through it. I'd rather wait a little longer but have everything work perfectly after the waiting time is over, which was my experience after the six weeks.

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If you had the kind of work where you worked from home on the computer (no lifting, etc), how long would you say it would be before you could have returned to work?

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Thanks Ed68391. Very encouraging. Sounds like 7 weeks is the magic number for you! I will post my aquablation story on a fresh thread. Appreciate any feedback.

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Owen, I had surgery on a Tuesday and was back to working from home (sitting at computer on a donut pillow) the following Wednesday, so I'd say an 8 day recovery to get back to work. My catheter came out after 48 hours. But the overall healing takes longer.