Mi experiencia con Aquablation

Salud del hombre
1

Hi everyone
Since Aquablation is a relatively new treatment for BPH, there is limited actual patient experience information out there, i wanted to document my journey. Hope it helps others who consider aquablation.
Before my aquablation operation:
Age: 59 , Latest PSA: 6.9 , PVR : ranges between 400-700 ml, prostate size: 66 ,
severe trabeculation, mild median lobe.

Background:
i was monitoring my PSA value since my early 50’s …it was 5 next year was 6 following year was 7, then it went up as high as 13(all these are approximate values)..finally it went down by itself(see above).
i didn’t have insurance at the time, so i didn’t go to a doctor but was informing myself about PSA values.
In the meantime my BPH symptoms started
First thing to consider is why a PSA value would increase…besides other factors(BPH) ,cancer could cause it to rise. To rule it out, went to doctor..had digital rectal exam..no cancer indication…
Now that i had insurance…had biopsy done(12 point needle)…no cancer..
So..my problem was BPH. I chose Aquablation because it is a minimally invasive robotic treatment, which preserves all other functionality in that area.
Fast forward..2 days ago (12/19/2022) i had the operation.
I know that the experience can change from person to person…this is my experience.
the operation was really nothing to worry about…you are under anesthesia , i woke up..procedure done.
had a catheter in and a bag. Minimal to no pain(as far as i know they just gave me tylenol)..
they hung 2 bags (each 3 Liter) of saline solution which was circulated through my bladder and out, to flush the urinary system…all night long replacing both bags every hour or so.
From other patients experiences ,i was expecting them to remove the catheter the next day and doing 3 pee tests to see if i can pee and empty my bladder, but my urologist told me that the plan is to release me from the hospital WITH the catheter and that he would remove it within 3-4 days.
So now i am home with a catheter and a bag..couldn’t get an appointment yet to have it removed.
Many people mentioned that they had constipation…i don’t have that experience yet as of today.
many people were kinda ok with the catheter..i am not..it is very uncomfortable because as you move the catheter moves in and out into your utethra..because of this, sometimes there is shooting pain at the tip of the penis..can’t wait until this thing is removed.
The urine is really bloody right now..which is expected…the important thing is to NOT have blot clots and so far there is none. many people also mentioned bladder spasms…which i didn’t experience so far.
i was prescribed an antibiotic to prevent infection…pain..minimal (with tylenol).
Also..each morning i had an erection(which was painful because of the catheter)..good sign nevertheless.
Will update my post as days pass.

2

Keep us posted on your progress. I also want to have aquablation done soon.

3

Thank you for documenting your journey. I’m waiting and now see my insurance is not covering aquablation, so back to square one. good to hear the catheter in the hospital was not bad as it is for some. too bad you had to go home with it since i would hate that too.

4

The catheter in the hospital was not bad because i was not awake when they put it in..also update: i could get an appointment at my doctors office to remove the catheter tomorrow morning. We’ll see how that goes and how it feels afterwards.
Sorry to hear that your insurance is not covering aquablation..actually my insurance (United Healthcare) did not cover it initially either stating that the procedure is unproven/experimental.
I appealed their decision and was lucky that they decided to change their decision and approved it.
What was the reason they gave you for the denial?

5

Are you using an urinary leg bag? Did you take any 5-alpha-reductase inhibitors before the procedure?

6

Yes i am using a leg bag. The only pill i was taking was Alfuzosin for about the last 13 months.

7

i’m still trying to get an answer. did you appeal it or did the doctor do it on your behalf? i’m finding i’m not supposed to do anything and they handle any appeal. is that your understanding or did you write a letter or call your insurance?

the official reason is it’s experimental/unproven but for my specific case i’m still trying to understand what happened. i was told that several insurance groups recently started covering it including blue cross of florida where i am a member (i’m in California though).

8

The denial letter i got from the insurance company stated that i could(or my doctor) ask for a peer review(between my doctor and their doctor) first and if that isn’t resolved then i could appeal.
But i also could skip the peer review and appeal right away..in this case afterwards i wouldnt have the chance for a peer review anymore.
When i asked my doctor that he should do the peer review , he told me that from his past experience , a peer review doesn’t lead anywhere and he suggested doing a Urolift instead, which i declined. At that moment i knew that i am alone in this.
So i gathered the required documents and did my appeal. 30 days later i received information from United Healthcare that they approved the Aquablation procedure.

9

My Uro told me that in the “early days” of Aquablation they used to send patients home the next day without a catheter. But he said that about half of them would would end up in the emergency room because they could not pee. So, now he does the surgeries on a Thursday and removes the catheter on a Monday.

10

thanks for posting !

where are you located and which doctor is doing this procedure ?

11

i am located in Port Richey, Florida. My Urologist who performed the operation is Dr.Tannenbaum. He is well known in this area and i heard nothing but good things about him and so far i can’t complain.

12

That makes sense..also to get it straight..i was not complaining that he left the catheter in. i prefer to have the catheter and not having to go to the emergency. It’s just very uncomfortable. It is what it is. In a couple hours it will be removed anyway.

13

Hi,
The Aquablation procedure is covered by Medicare and several insurance providers according to the Aquablation website (aquablation.com) which states: “For patients in the United States, Medicare and several of the major national private insurance companies have issued positive coverage policies for their patients. For all other private insurance companies, coverage can be assessed on an individual basis, and you should speak with your provider directly to determine if Aquablation therapy is available for you.”

I have been studying Aquablation for over a year now watching several medical institutions pick up the procedure. I’m in Missouri where only one Urologist now performs the procedure, but there are several in Arkansas. The problem I am having is getting a urologist to handle my case. I have a 32gram (small) prostate and very large median lobe. It appears the urologists prefer to use Aquablation on large prostates because I presume there is better outcome/risk?? I did see on a patient forum where a urologist in New York is using Aquablation successfully on anatomy like mine. I just hate to have to travel to New York to get the procedure.

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12/22/2022 UPDATE
Today in the morning at 08:30 am the catheter was removed..removal pain is like ripping a bandaid off..not fun but not too bad. Was told to go home drink 1 liter water and see if i can urinate…if not..don’t keep drinking water because it will overfill the bladder and that’s a problem…if you can pee then continue the same and come back for evaluation at 2:30 pm . I did as instructed..initially i couldn’t pee but then an hour later i started peeing every 30 minutes…Of course bloody and some dead prostate tissue and blood clots..and the urethra burns but nothing extreme. Went back for the evaluation in the afternoon. Peeing test..good..but the PVR was around 250 ml..it should have been 150ml and less.
Was told that i need the catheter again..i declined. Told the nurse that over the course of 7 months my PVR was ranging from 400 ml up to 700 ml..which is dangerous because the urine can backflow into the kidneys and cause pain and even worse damage to the kidney , also possible kidney infection, kidney stones..etc. Told the nurse that i had kidney pain 3-4 times already during the 7 month period…so..i’m happy with 250 ml..besides..i have severe bladder trabeculation , which means my bladder lost its flexibility and that explaines the higher than normal PVR. Maybe my bladder can fix itself , maybe not.
Either way today it was the first time since a loong time that i had somewhat decent flow. Nurse was convinced but gave me 10 or so catheters just in case i need it. Explained how to use it…recommended drinking a lot of fluids for the next week or two.
i am grateful that they did not insist on putting the foley catheter back in. Did i mention that i hate that thing.
i will keep posting

15

Hi guys - I had an aquablation done on Dec 15th at a hospital outside Boston. Im in pretty tough shape over a week later, and Im thinking this was a big mistake. My experience:

Catheter was removed the next day in the hospital. After it was removed, I was gushing blood from my penis and had absolutely no control of urine function. The urine I passed was beet red. I felt that something was seriously wrong, but they insisted this was normal and over my objections they sent me home after I urinated twice to their satisfaction.

They would have allowed me to stay, but when i suggested that i thought i should stay and they should put catheter back in, they refused to put catheter in and made it clear that if I stayed they weren’t going to do anything for me. for the next two hours i was completely ignored. So I called my wife to come get me and pick up some depends for me to wear!

The past week has been miserable. The good news is that my urine control has improved considerably but not completely. Still wearing depends, because sometimes I dont get much warning, and sometimes I dribble. Im also spotting blood or bloody urine throughout the day. I will say the urine stream is more forceful than it has been in years. Now it is more the color of strong iced tea, so i guess thats an improvement from when i first got home.

I was completely constipated and unable to have a bowel movement for the first five days, despite stool softeners, then moved on to laxatives. on the fifth day I added prune juice and castor oil, which finally did the trick. But now im constipated again. This is all highly unusual for me. Normally I would have a regular movement every morning, With no difficulty.

I am experiencing erections during the night and waking up with an erection, as is normal. But they hurt. Used to be fun! Ive been told no sex for six weeks, so im not doing anything to cause erections.

There is a constant pain in my urethra, from tip to base, which seems to be at its worst when I sit in a wooden chair. not a terrible pain, but a constant discomfort. It is uncomfortable to urinate.

At this point I am regretting that I had this procedure done. My BPH was causing significant problems, especially lack of sleep and occasional inability to pass urine. However, I never worried about incontinence, and I never worried about wearing depends for the rest of my life.

I am really angry at my doctor for not explaining adequately what the recovery from this procedure would be like. I do not trust him at this point. I would like to think that my recovery is still a work in progress, but the improvements have slowed. It may not get much better. i have the feeling that something serious may have gone wrong during the procedure, and the doc and his team are covering it up.

I certainly never would have voluntarily submitted to a procedure that would leave me with this degree of incontinence, if I had known going in. I feel duped and regretful.

I hope others have a better experience than I have had. If anyone is considering this procedure, please think twice and insist upon a frank discussion about the recovery process with your urologist.

16

BTW, did you sleep on the first night at the hospital? when they were coming in to change the bags. Does that wake you up?

17

Couldn’t really sleep..each time they came to change the bags, i woke up..so..pretty much every hour i woke up and fell asleep again. And i have to say that in general i have no sleeping problems..i can sleep through almost everything, but the hospital is a different environment, you don’t sleep in your own bed…etc..

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UPDATE 12/24/2022 day 5 after aquablation.
The day after catheter was removed (12/23/2022-yesterday) my urine flow completely stopped for about 4 tries over the course of 6 hours (i was peeing every hour prior to that), and i started to seriously consider using the catheter that they gave me because i could feel my bladder being full.
i thought maybe there is inflammation that caused this and took 1 pill ibuprofen in hopes it would help.
By the way up until this happened the amount of blood in the urine gradually had gotten less and less.
Also i forgot to mention that the nurse told me to keep using Alfuzosin until further notice.
So..i took ibuprofen and Alfuzosin…1 hour later i could pee again with much less flow but this time the burning and stinging sensation was way more than before and had a lot more blood again. I was still happy that i at least didn’t have to self catheterize(did i mention that i hate that thing..lol).
Last night i slept a total of 8 hours and had to go pee 2 times(compared to 5-6 times before aquablation).
I am not worried about my situation thanks to the posts i read here on this forum from other people who shared their experience..this is also the reason i am documenting my experience in hopes it helps other people.
To really make a realistic assessment i have to wait at least a couple weeks..i am patient.
Will keep posting.
Merry Christmas to everyone.

19

Wow. I actually was kinda shocked when i read your post. The reason i had chosen Aquablation was that the compentency/experience of the doctor is not that relevant because it’s performed by a computer(other than the programming of the procedure). I want to think that you hopefully recover from all of it eventually. My experience seems to be better than yours but i have to say that the doctors really don’t explain the recovery portion of this whole journey. If it wasn’t for the other people’s experience sharing in this forum, i would probably also freak out.
Example: it is now day 6 after the aquablation and i have difficutly urinating..the flow is not that good…it really hurts and burns while peeing…and there is still a lot of blood coming out.
i also have minimal control with the flow…i have control over starting and stopping but once started , i can’t control the flow(but i also don’t want to strain and just let it go).
i don’t have constipation though. As mentioned before…every person is different.
I still believe that all this is normal, but if there is no improvement after 2 weeks , then i would worry also. We need to give our body time to heal…think positive.
I would like to hear how your experience goes…so pls post updates.
I am trying to post updates whenever anything changes…this will help others to understand what to expect.
Merry Christmas

20

Try lignocaine gel for the catheter pain, I had Rezum 5 weeks ago, catheter for 8 days, would have been intolerable without the Lignocaine. Good luck!