Aquablation - 7 Weeks Later - Does it Get Better?
Posted , 15 users are following.
I am 56 and had Aquablation on Aug 18. I did some earlier posts stating that I was happy about how the procedure went but I feel like over the last 3 weeks or so things have really plateaued and gone back a bit.
The clearest benefit of the surgery is that my bladder holds much more and I don't have to strategize my daily activities around bathroom locations. The problem is, once I have to go, I REALLY have to go, even worse than pre-surgery. There is maybe a 5 minute gap between feeling the need to go and wetting my pants and I've had some unfortunate incidents on the way to work.
Stream: The good news is that I don't have any super slow and thin streams like before surgery. On day 4 after the surgery I did pee like a racehorse but it seems to have slowly but steadily gone backwards since then. It now seems to be on the high end of what it was pre-surgery.
I met with the nurse practitioner 2 weeks ago today who advised patience and said my prostate still looked like it had a really bad sunburn and was still recovering. In fact, at least until last week I was peeing out noticeable chunks.
So, I would say a mixed result from surgery. Not horrible but not as good as I hoped. Question to people who have been through this: I am almost seven weeks post-surgery, is it likely to get better?
3 likes, 54 replies
cali-mike1970 michael55618
Posted
how are you doing now? are things stable or getting better?
what does your doctor say about your recovery? were there any other complicating factors -prostatitis or CPPS? bladder issues?
michael55618 cali-mike1970
Posted
Hi Cali -Mike, I am planning on doing a longer update next Tuesday which will be two months post-surgery. But to preview it, things seem to have stabilized and improved a bit. Over the last week, I have been shedding a lot of tissue when I pee and this has coincided with my improvement.
I'm sleeping about six hours a night before getting up to pee. The maddening thing is that my brain seems to be on autopilot when it wakes me up. I usually don't feel an urgent need to pee but yet my brain does not want to go back to sleep without a bathroom trip.
No other complicating issues. The advice at my last doctor's visit a few weeks ago was that things are going well and be patient.
I know from your other posts that you are deciding on which option to try. I wish you the best.
compiler michael55618
Edited
Thanks for sharing your real experience. Your doctor office nurse practitioner told you your prostate still looked like it had a really bad sunburn. Did they prescribe you any medications after the procedure?
michael55618 compiler
Posted
I was told to stay on Tamsulosin for three weeks after the surgery. When I returned for my followup about a month after the procedure and was not feeling very good, the nurse practitioner told me to go back on the Tamsulosin for 2 more weeks. So, now I'm off the Tamsulosin.
compiler michael55618
Posted
Tamsulosin is not anti inflammatory drug. It unlikely relieves "looked like it had a really bad sunburn".
michael55618
Edited
So, here is my 2-month post-surgery update. As I have mentioned in other posts, I am 56 and otherwise healthy (ran a 5K last weekend). I am happy to say that I am feeling much better than two weeks ago. Some additional rest and medication helped. But Aquablation recovery really does take 2+ months
When I was discharged from the hospital the day after surgery, I was told to stay on Tamsulosin for 3 weeks, not to exercise for 3 weeks or to lift anything over 10 pounds, and no sex. This was overly optimistic advice but I learned the hard way. At 3-weeks, I stopped the Tamsulosin, waited a couple of days to start exercising, and waited a few more days before sex. I almost immediately started to feel worse but thought that it was strictly the lack of the medication. When I met with the nurse practitioner 33-days after surgery, she told me that I needed to stop exercising and go back on Tamsulosin for two more weeks. I had the impression that she had had this same conversation with other patients. My advice to anyone who has Aquablation would be to wait at least one month before resuming normal activities. Stay away from any kind of bike for at least two months.
After my initial post two weeks, I started to notice brown tissue of about 1 mm in my urine. The following weekend, I was at a public urinal when all hell broke loose, or that’s what it felt like. Numerous pieces of tissue came out, a couple as large as 3-4 mm . It momentarily made me wonder if my prostate was disintegrating. Based on the nurse practitioner comparing the condition of my prostate to a bad sunburn, I assume this is just part of the healing process. The shedding continues at least as of yesterday, but no tissue in recent days larger than 1 mm.
Here is the breakdown of my condition:
SLEEPING - Over the last week, I have typically been able to sleep for 6 hours before using the toilet. Last night I did 6 hours and 40 minutes. I have been letting myself drink more water in the evening, so on some nights I have to get up after 2 hours, but then I sleep soundly for the rest of the night.
STREAM - Nothing to brag about at my next HS reunion, but it is a bit better than my best result pre-surgery on Tamsulosin. And it is consistent at this level.
EMPTYING - I have not had a sonogram the past three weeks, but I am emptying my bladder. When I feel my bladder is full, I typically do about 20-26 oz. of urine. I usually maxed out at 14 oz. pre-surgery.
URGENCY - Still a work in progress but this has been the biggest improvement recently. It was so bad for a while that I was actually wetting my pants. It’s not yet where I want it to be, but I can control it and as I said I can let my bladder fill to over 20 oz. without fear of an accident. But my prostate is still very sensitive. Simply bending over can make me need to use the toilet.
DRIBBLING - I clean the bathrooms in my house and when I cleaned them last week, I realized that the floor in front of the toilet has not needed extra attention for a while because I no longer dribble pee on the floor.
SEX - All systems go!
I will try to do another update at the 3-month point.
compiler michael55618
Edited
Helpful info! Probably the statement " After Aquablation therapy, most side effects typically resolve within two to four weeks" to at least one month!
How about the urinary frequency by comparing before and after the procedure during the day, every 2, 4 or more hours now?
michael55618 compiler
Posted
I was probably once an hour before surgery. I'm mostly in the 2-4 hour range now. For breakfast I drink two cups of coffee and a lot of water (plus milk in my cereal). After this liquid intake, I might go twice in the space of an hour but then less frequently as the day goes on.
michael68883 michael55618
Edited
I am considering aquablation also. I am 57 with an enlargeed median lobe and now self cath. Thanks for all your info. still a bit apprehensive about the surgery though. Did you have a median lobe problem also?
macindian michael68883
Edited
@michael55618 Thank you so much for keeping us upto date with your progress. I am 59 with a prostate size of around 40cc. I have been taking medications since June 2020. My PVRs are usually greater than 500cc. I have started doing CIC for the last 3 months to rehab my bladder. But have suffered 4 UTIs in the process. My urologist has been recommending Urolift since last April 2021. Even since I found about Aquablation, I have been holding out. But my urologist is not keen on Aquablation considering the high PVR and possible side effects.
Your progress has given me hope. I am meeting my doc again next month and I will see what he says.
Thanks.
compiler macindian
Posted
Your doctor probably is right for the 40 cc prostate without median lobe. Have you tried 5-alpha-reductase inhibitors?
macindian compiler
Posted
Yes, I had been taking Proscar (Finestride) since June 2020. I recently stopped it in August on the advice of my urologist who suggested that I start doing self-cath to rehab my bladder. I am wondering if PAE would be a good solution to reduce the size of my prostate.
How many years can you take 5-alpha-reductase inhibitors for? I didnt see too many side effects and I could resume Proscar if that will keep my gland from growing.
michael55618 michael68883
Posted
You know everyone on here is still so much more educated on the terminology than I am that it is a bit embarrassing. But the notes from my office testing a month before the surgery state "lateral lobe hypertrophy and intravesical median lobe (estimated 70 grams)".
Maybe someone can help me out here, but I believe the answer to your question is yes.
michael55618 macindian
Posted
When you say he is not keen on it due to the high PVR, are you saying that he is not keen on it because of your current PVR, or because he thinks you will have high PVR post-Aquablation? If it is the former, I can tell you that a month before surgery I was tested three times and each time I was retaining over 500cc. In fact, on one of the tests it was over 700cc. The nurse practitioner was seriously freaked out and wanted to put a catheter in right away.
compiler macindian
Posted
Finasteride probably can be taken indefinitely. But, after about 1.5 years it seems reaching the maximum benefits. If one stops the finasteride, the BPH symptoms can return and even worsen rapidly. Ask yourself, are you willing to be on the medication indefinitely? Does the medication satisfy you? As for the PAE, you may search this forum. The user reports it seems not working very well. The American Urology Association (AUA) Guidelines for the surgery treatment is refractory retention or any of the following clearly related to the BPH: Persistent Gross Hematuria, Bladder Stones, Recurrent UTIs, Renal Insufficiency. If the patient chooses noninvasive therapy, the choice is watchful waiting or medical therapy. If the patient chooses invasive therapy, the optional diagnostic tests are pressure flow, urethrocystocopy and prostate ultrasound prior to the surgery.
macindian michael55618
Posted
@michael55618 I have high PVR now due a weak (atonic) bladder. It fills up to about 700 cc when I get the urge to go. I then empty out around 100-200 and leave the rest behind. Thats the reason, my doctor thought Urolift had a very small chance of success and probably same goes for Aquablation.
Did your PVR volumes go down post-Aquablation procedure?
macindian compiler
Posted
You are absolutely right. I dont know want the BPH symptoms to return. I will probably resume Finasteride soon after consulting my doctor.
michael55618 macindian
Edited
Yes, I've been tested three times post-surgery. The nurse told me that post-surgery they are looking for retention of less than 75cc. I had one test where I was 83 cc but two tests where I was less than 75cc. So, that was one big area of improvement for me.
compiler macindian
Edited
Urinary track obstruction worsens and PSA level increases!
macindian michael55618
Posted
This is very encouraging. I wonder even with my weak bladder once the obstruction is cleared, my PVR will also go down. You have given me hope. Thanks. Also, I resumed taking Finasteride from today to keep the prostate size in check.
cali-mike1970 macindian
Edited
40cc is too small for PAE according to a respected IR doc i just emailed about this, he gave me these ranges:
macindian cali-mike1970
Posted
Can Aquablation work for 40cc prostates? My urodoc is not willing to recommend and has mostly determined that CIC will be my life going forward due to high PVR. In fact, he told me to stop taking Alfuzosin and other meds when I met him 2 days back. I dont know if I will get any normal void without the meds.
cali-mike1970 macindian
Edited
yes based on the open water study (all comers)
https://www.procept-biorobotics.com/clinical-data-aquablation/
first study 50-80
second study larger prostates than 80
open water study - any size including down to 20cc
macindian cali-mike1970
Posted
Thanks @cali-mike1970. The studies clearly show that the procedure works for smaller prostate too. I wrote to my urodoc and replied that he wants to try Urolift first.
I will try to consult a different doctor and see if he is willing to do Aquablation. My problem might be the high PVR due to a low Bladder Contractile Index. I saw in the clinical study that the patients selected did not have a PVR similar to mine. I think I have two issues - high PVR and blockage due to englarged prostate. The hope is that clearing the channel might rehab my bladder over time - something that I am trying to do with CIC and meds.
keith195567 michael55618
Posted
Hey buddy
Glad that you are doing better. So you say all systems go. Does that mean. No problem with erections no loss of ejaculation and orgasms are the same.
Just give it more time all men are different and we all heal in our own time.
All the best....Ken
keith195567 michael55618
Posted
Hey Buddy
Glad you are doing better. Can you tell me do you still have your ejaculation?
Or do you have retro?
Just checking. Rest when you can......Ken
michael55618 keith195567
Posted
No retro. Really everything is fine for me except the stream is a bit weaker than expected and PVR is a bit high due to scar tissue.