Aquablation

I wonder why the recovery would be longer? The actual procedure time is typically less than ten minutes. Further, no heat is used, but clearly the prostate is traumatized.

To me the laser procedures are still first choice for life back to normal on day two and for me twice a good result. GL lasted or nine years and my Thulium/Holmium was done in 2013 and no later problems

Everybody needs to pick their favorite. Certainly, if you dont mind the higher risk of RE with laser based procedures, and you have a great surgeon, no argument here. My doc does TURP, HoLEP, Rezum and Aquablation. Its great having an unbiased adviser like him. This decision was not easy!

Each time I had a Uro who then specialised in the procedure I was having given older procedures for the new ones. UK surgeons tend to specialize .

Not everyone is fine day 2 after GL. Some people are fine day 2 after TURP too, but most aren't. My URO told me to expect to need pads or depends for at least 2 and up to 4 weeks after GL and that RE odds were 50/50 so I waited for Rezum. Yes - some will mirror your experience and be all but fine in a couple of days with no RE - but some also wear diapers for a month and have RE for life.

I think that your Uro was putting you off a procedure he didn't want you to have. That is certainly not the case with people I know and meet. Why can we UK patients have better results than Americans ? RE odds are very likely 50/50 or less due to many factors. It always amazes me when I hear of people wearing pads for weeks. I had no worries travelling home by train on day two and day three I was happy being out and about as normal and being surprised at not having thought toilet all afternoon.

This was a post to a NG in around 2003 by one of the first GL patients was from Patrick who was one of the earliest PVP patients and he was only 44.

He was back to normality in no time and flew from LA to Japan on business on

day four or five. He posted for years on a prostate NG before

stopping but later came back years later to tell us that he was being treated

for prostate cancer.

" I promised to report

to this group how things went with my laserscope PVP procedure.

To give you

an idea of my condition:

44 yrs old

suffering from BPH for many years

Urodynamics, Ultrasounds and cytoscopes showed a

70 gram prostrate with large middle lobe causing severe bladder outlet

obstruction.

peak flow was 5 ml/sec

post void residual over over 300 ml

taking Cardura 8 mg/day

AUA symptom score: 32

Quality of life score: miserable

I got to the

point that a TURP was absolutely imperative as kidney and

bladder damage were inevitable.

I chose to

have a Laserscope Photovaporization of the Prostate because based

on reported results and comparison with other type of TURPs, this type of

TURP had the best results with a minimum of side effects.

I am now 3

days post surgery and am pleased to say that the surgery has made

a huge improvement in my condition.

1.

Flow is incredibly strong, not measured yet but has to be greater than

20 ml/sec

2. Bladder feels completely emptied.

3. Urgency nearly non-existant

4. Frequency greatly reduced.

AUA Symptom

score: 7

Quality of life: very pleased

• The

  surgery was done as an out-patient at a hospital under a local prudial

block and light IV sedation.

• There was

  no post-surgury catether required.

• Blood in

  urine was very light and lasted 24 hours. No bloods clots.

• No post

  procedure pain whatsoever.

• Tired and

  achy for two days post-surgery.

• Felt

  normal on day 3 post-surgury except for tip of penis irriation.

So for me,

the laserscope PVP

worked well.

Note that

Laserscope is not just another laser TURP. The 80 watts of power

at the wavelength of 532 nm makes it able to completely vaporize prostate

tissue without bleeding and with only an 800 micron penetration depth and a

heating depth of only 1 to 2 millimeter.

No other laser or electrovaporization technique vaporizes tissues without

minimal colateral tissue damage.

I am open to

answering any questions you might have.

Patrick "

So, Derek, is the take away here that you believe all these new BPH procedures are superfluous and are actually inferior to laser based procedures.? That concerns about RE with laser based procedures (like TURP and HoLEP) are overblown and are trumped by their cauterization abilities, reducing post op bleeding?

I respect your opinion, I just want yo clarify.

Marty

Anecdotes are just that. Overall numbers are much more instructive given the variability in recovery and results from various BPH treatments. The numbers suggest fewer permanent side effects, shorter recovery, and no anesthesia risk with Rezum, PAE and FLA. Of the three, there are better numbers on Rezum - both in terms of studies and insurance acceptance.

For every 2 day recovery from laser procedures on this forum there is someone in diapers for life. Neither are likely, both are possible.

I give my opinion by the results of the two laser procedures I've had and that of friends. As I live in a holiday resort and a town popular with retirees I meet a lot of old Guys and health always crops up with prostate high on the list. Those who have had mainly laser surgery are happy those on drugs describe themselves as miserable. I only know one Guy who had a really bad result.

All the newer ones seem to have much longer recovery times and some evidently a lot of post op bleeding. The lasers cauterise the surface and there should be no bleeding. The urethra suffers trauma from equipment and my spurts of blood at the start of urination evidently came from there.

The new ones are popular with urologists and our NHS as they are cheaper and mostly quick to do.

If you google mr gordon muir urologist and have a look at his video section there is a lot of good information on it.

Thanks Derek, very informative Muir YouTube. Interesting that new GL techniques limit chance of RE to less than 20%. YouTube is 3 years old, so maybe even better today. I can see your point.

That being said, Muir also goes to great lengths to emphasize the role that surgeon skill, experience and training play in getting the optimal results with GL and TURP. He makes it sound pretty involved, and even states that some docs doing these procedures need more training.

For bleeders and high risk patients, laser is a good first choice, from what I’ve learned from Dr Muir. However, given that Aquablation is proving to confer similar results to the (optimal) results of laser procedures, without any reliance on surgeon skill, I see it as a welcome alternative (for non-bleeders). Taking surgeon skill out of the equation seems like a good thing to me. We'll see how the Aquablation track record develops.

He did a friends GL in 2005. It was a very small prostate but very obstructive and he was self cathing. His flow has slowed and he went back to him a couple of years ago

but he said one a day cialis would suffice.

Notice he said that initially we thought it was a quick and easy procedure but we realised it needed more time and care. Before my last procedure I went to see Tim Larner who was the other who started GL here and he said the same. I did not go to him as it involved more travel and Thiulium/Holmium in my home town was going to save tissue for histology. As I had been taking Warfarin I had some bleeding and went home with a catheter in as the NHS like to free up beds as quickly as possible rather than keep me for another day.

From the sound of the Forum it is American Uro's who need more training 😃

Diapers for life ? Is that myth or your vivid imagination ?

google nr gordon muir urologist as open minded Marty has.

Derek,

Mr “Open minded” here again (my wife would take issue with that characterization). On page 13 of 38 of the 2018 NICE study comparing TURP vs Aquablation, it says 42% of TURP patients (with beginning prostate sizes 50ml or larger) developed anejaculation, whereas only 2% of the Aquablation patients developed the same problem. I quote from NICE:

“In sexually active men, mean erectile function scores (IIEF-15) were stable after water jet ablation and decreased slightly after TURP except for overall sexual satisfaction where water jet ablation was statistically significantly better (p=0.0492).

Ejaculatory function scores (MSHQ-EjD) were stable after water jet ablation but worsened significantly after TURP (p=0.0254).”

At the risk of not appearing analytical, YIKES!!

Dr Muir said those patients treated with GL, using a “special technique” that skilled surgeons know, only had a 20% chance of RE. I don’t know, as you’ve noted, if all USA surgeons are using that technique, but it’s worth investigating if someone in the USA needs a laser based procedure.

We all should remember Mark Twain’s observation that there are three kinds of lies, in order of severity:

1. Lies
2. Big lies
3. Statistics

I must admit, the statistics in the NICE Report confuse me, but the narrative puts Aquablation ahead of TURP in almost every category.

My opinion: I guess we can trust NICE, so I’m no fan of TURP! I love avoiding surgery or at least taking the surgeon skill factor out of the equation, so I am a big fan of PAE and Aquablation, and a newly minted admirer of GL and HoLEP (thanks to you) for people with bleeding issues for whom PAE did not work.

Just to finish the field, in my opinion Rezum is too reliant on surgeon skill and has no benefit over Aquablation, and has longer recovery times and higher chance of RE, and Urolift - a spectacularly simple procedure - leaves too much hardware in the body, something that I personally just can’t get comfortable with.

I hope I haven’t lost my unbiased standing!

Day 16 of my Aquablation recovery, all is well. Slight trickle of blood sometimes when I pee. My wife loves my new happier demeanor, higher energy levels and willingness to travel anywhere and go to the theatre. I hope this recovery lasts. I think she’ll leave me if I relapse.

Marty

Hi Derek76- Did you have retro after the GL surgery? [Of course it's a given that you have retro after the Holep.

After my GL we went New Zealand and travelled around for a month on busses without toilets. Only once was it a bit of a problem. The most amusing toilet country was Morocco. The bus pulled up in the middle in the middle of nowhere and I asked the driver why as passengers trooped off. Toilet stop ! he said. The robed male and female passengers squatted either side of the vehicle.

My friend with the small prostate had sex on day five after GL. I waited to day 15. Gordon Muir is critical of some of the NICE recommendations.

I don't understand how prostates that must continue to grow under their restrains don't suffer damage or break free.

This is from a very early UP GL patient in 2003.

Had PVP at the Ashdown Nuffield Hospital at Haywards Heath, UK on

Tuesday, Jan.13th, under Tim Larner. Herewith summary of events:

Tues.13/1/04:

10.35 Checked in - having already undergone pre-admission tests last

month.

14.00 - 15.30**: PVP (general anaesthetic)

16.00 Back in room. Bladder painful (see ** below). 2 CODYDAMOL

tablets

cooled that down within an hour.

Oxygen mask (until 17.50), saline drip (until19.40), catheter until

next morning.

17.50 Enjoyed 2 large salmon sandwiches & salad, + banana & hot choc.

No pain or even discomfort - not even from catheter, surprisingly.

Started reading Ludlum novel 'Treveyne'.

22:45 Hot chocolate, lactulose, + assortment of pills/tablets (incl

sleeping pill).

Wed. 14/1 (PVP+1)

07.50 Cup of tea. No pain - not even discomfort (even from catheter).

08.15 Breakfast

09.30 Catheter out after Larner' visit. Hardly a twinge, surprisingly.

Hadn't looked forward to catheter, but it wasn't really a problem

(except need to avoid rolling over on wrong side!). And it was nice

to

be able to knock bedtime drinks back without having to get up during

the night!

10.15 Hot bath!

11.05 Cranberry juice

11.25 First post-PVP pee (300ml)! Dark pink, but good flow and no

hesitation. Little discomfort, surprisingly.

12.15 3-course lunch

12.30 2nd pee (400ml). Still quite pinky. No discomfort. Checked no

residual (ultrasound).

13.30 Left hospital. Walked to HH railway station (10 mins)

14.05 Caught train to Southampton. determined not to use train WC!

15.40 Arrived Southampton. Just held on long enough to get to WC. Flow

not as good as first 2 pees, though. Disappointing...

17.00 Home. Already peeing clear urine - and has stayed that way,

except for the odd drop of blood from penis tip at first.

They started me on 25mg VIOXX (Rofecoxib) anti-inflammatory tablets

(1/day), and 500mg Ciprofloxacin (2/day) and sent me home with 7 days'

and 14 days' supply respectively.

Overnight at home was up every 1-2 hours, and flow was even worse -

almost back to pre-PVP - in fact the first (01.30) I thought I had

gone into full retention - scary. I hope this is quite temporary -

presumably due to swelling due to traumatisation by instruments.

PVP+2 (Thurs)

In the morning I felt so well - no discomfort even - that I played

snooker for 1.5 hours, then had a lazy afternoon.

No toilet calls from bladder between 10.30 and 12.45, although when I

got home and started thinking about it, all of a sudden there was a

strong urge to go and I hardly made it to the WC in time!

Felt perfectly normal the rest of the day. No urgent bladder calls...

Kept off alcohol, although no one had said I should. Just thought it a

good idea pro tem. Was it?!

Overnight, up 3 times (not due to urgency, but because something woke

me up and there was some feeling of something in there, so went out of

habit, I suppose). But flow still pathetic.

PVP+3 (Friday)

Felt entirely normal apart from much discomfort overnight due to

bowels still gummed up from the general anaesthetic. (This has been by

far the biggest post-op nuisance!) Amazingly, still no discomfort

peeing, bearing in mind all the things that had gone on down there

during the op, including destruction of that part of the urethra

within the prostate., and (see ** below).

Also, at last - after downing several dollops of lactulose - Mafeking

has finally been relieved...

However, flow is still abysmal. Has anyone else had this in the

first few days? Is it simply some swelling somewhere that will soon

go away, or could it be some debris that is partially blocking flow

(which was quite good for the first 2 pees on PVP+1)?

WC visits during the day have been more than pre-PVP, as drinking

water more often; about 2-hourly, but if ignore gentle 'WC visit

indicated' signals until the 'Quick, get in there' signal then there

isn't much time to spare!

So, to summarise so far, an incredibly fast and painless recovery, but

• so far - with a dismal flow rate.

Will post further if anything changes (hopefully improvement in

flow...).

(Would, welcome others' thoughts on latter.)

** Before doing the PVP, Larner did his routine check of the bladder,

where he found 3 small 'pre-tumour's, which he removed using

'diathermy',

taking samples for biopsy. He said they were the benign kind that grew

outwards rather than into the flesh, but that I would need to have

regular checks as they tended to grow back (like basal cell carcinomas

presumably) - or perhaps he was just saying that to stop me panicking.

Is a bit scary...

Anyway, that presumably explains why the op took so long (35 mins for

the PVP, 55 for the bladder), and why the bladder hurt afterwards.

Strange, how being able to pee can be such a game changer: Buses without toilets, going to theatre, sport events, spontaneuos travel, etc. Most important, I can now drink the fluids my body and brain requires and get the sleep required. It is nuts not to get BPH fixed asap! Life is too short . Enjoy your life in the

resort, may the flow stay with you!

No retro they did a bladder neck sparing version and my median lobe was not the problem area but the lateral lobes.

Marty,

In my research Aquablation does have its advantages and I would have gone for the procedure except that 1) it wasn't covered by my insurance, 2) it wasn't done anywhere near me. So, I went for a bipolar TURP, fully covered, done 2 miles form my home, checked into the hospital at 6am and home by 10:30am. Very easy.

Good to hear a positive report on the Aquablation.

Tom

HI Tom,

Glad to hear your TURP worked out well. Yes, same day outpatient is a great feature of TURP that Aquablation does not presently offer. Probably never will, with all the bladder flushing that is done post op for 24 hours.

Marty

No - you can find plenty of them on this forum from each of the laser procedures. They aren't the norm - and neither is your quick recovery. When investigating procedures, rather than react to anecdotes, its best to look at the overall averages. There is less risk, with fewer side effects and shorter recovery ON AVERAGE with Rezum, FLA and PAE than the leaser procedures. There is also less of a chance of a permanent screw up if you end up with a lousy uro.

You can always have a laser procedure done if something less invasive doesn't work.

GL has been round for 16 years. Would it still be used if as you say ? HoLep and other laser procedures have not put it off the market. Why not and it's now in its third generation ? There would be public uproar if a million men as you hint were going around in diapers. Have you invested in diaper companies ... they must be booming.

Perhaps you and oldbuzzard are both right. The need for diapers is not out of the realm of possibility for any BPH procedure. My doc warned me that after years of fighting obstruction the bladder may need a month or two to adjust after surgery; it may create urgency with an uncontrollable need to go that gives you very little time to get to the WC. If you have this condition and won’t be near a WC, he told me you may want to wear diapers during those times. This is a temporary inconvenience, not a lifetime condition, and not limited to laser procedures.

Theoretically, a laser surgeon could go too far up the urethra and zap the sphincter bladder muscles, but I havent found such cases in my brief search on the web. This is probably more malpractice than a common event.

Play nice!

I just found this. This is an excerpt from a NCBI published study entitled

“Risk Factors for Transient Urinary Incontinence after Holmium Laser Enucleation of the Prostate”:

“TUI is one of the most bothersome postoperative complications of HoLEP, both for patients and clinicians [2,7,14]. Involuntary loss of urine with a hygienic or social problem decreases the quality of life of patients significantly, and the complaints of the symptoms of incontinence can be very stressful to clinicians.

In several studies, TUI after HoLEP was shown to occur in up to 20% of patients, most of whom recovered within one year [2,7,14,16]. Shah et al [4] reported postoperative TUI in 10.7% of their sample; all but two of the patients showed improvement after a mean duration of 42.3 days (range, 1~110 days). In the present study, postoperative TUI occurred in 16.6% of all patients, 80.0% of whom showed recovery within three months. As shown above, the occurrence of postoperative TUI varied widely across studies. The main cause of these differences may have been the variation in the definition of postoperative TUI in each study. We defined any involuntary urine leak as TUI, including stress or urge urinary incontinence and postvoid dribbling. However, many other authors defined TUI exclusively as a complaint of stress urinary incontinence. Because postvoid dribbling can also disturb the lives of patients, our definition of TUI (including any kind of urine leak) seems to be more appropriate.

In the present study, the main predicting factors of the occurrence of TUI after HoLEP were the age of the patient and the total operation time. Older age and a longer operation time seemed to cause postoperative TUI more often, as well as delays in the recovery from this complication. We suggest that these factors are associated with urethral sphincter damage because of its compression, stretching, and tearing by the resectoscope during the operation. Older patients may have more fragile and sparse sphincteric tissue compared with younger ones; this may lead to increased susceptibility to damage caused by forcing the tissue.”

Of course it would. There are still plenty of docs who do the old fashioned TURP too - that doesn't mean its the ideal first option for most men with simple BPH.

And I never said that a million men are going around in diapers. What I said was that for the first month, its a common problem - that my uro told me to expect it and be happy if I was one who didn't end up with it. "depend on it" were his words. I also said that while rare, there are some botched GLs that resulted in permanent incontinence - which is also true. There was someone (I think his name was Glenn) on this site who outlined it. I went on to say that with the three procedures I mentioned as better first options, the worst case scenario is wasted time and money with no results, not a permanent problem, without the risk of anesthesia and very low risk of RE. They also leave the option of doing a laser procedure if the results aren't satisfactory..

I stand by what I said and think that the research backs it up . Everyone has to make their own decision based on their doctor, insurance, priorities and pathology. Again - Derek had a great result with GL - which was not typical. The ones who end up incontinent permanently aren't typical either. The three risks with GL vs the others I mentioned are:

1. RE. 50/50 with GL
2. Anesthesia
3. Messy recovery with incontinence for a number of weeks
4. Rare, but permanent incontinence in the wrong hands.

Marty,

Here's what I have learned here about the TURP recovery immediately after the operation: if the patient stays overnight in the hospital there is a long time for the bladder irrigation, and then the patient goes home with no Foley (in most cases). In my case, there was no overnight hospital stay and I went home with a Foley and it was in for three days. Some people don't mind being in a hospital overnight, but in my case, I get extremely bored in the hospital bed, my back hurts, I can't sleep etc. I had a terrible overnight hospital stay in 2006 after a mild "cardiac incident" - one of the worst nights of my life. I even hated the 6 hours on my back in the recovery room after my PAE in 2017, so going home right after my bipolar TURP was very important to me.

Tom

Tom,

I understand your wanting to get home. I guess they could irrigate aquablations less in the hospital and send patients home with a foley the same day. I was glad to stay until the debris (prostate tissue) stopped appearing in the foley. They took it out the following morning and sent me home. I was not given option of leaving the same day. Perhaps that protocol will change.

Marty

We call them Nappies here and babies wear them and unfortunately some ladies:-)

The pharmacy shelves are full of them but I don't notice ones for Guys.

I can honestly say that no post prostate laser surgery apart from one I have met has ever said they needed them. The one had a surgeon I would never go near after one consultation with him. Another of his problem patients was in the next bed when I had my second procedure.

By the way I have saved 13,000 posts from the late 90's till now on a bph news group and no Brit posters had reported nappies to my memory. People here seem to live in a bubble that news group previously like this mainly inhabited by Americans still exists plus another big American health forum that covers all health aspects.

The one that worried me most was Anesthesia as my previously fit and mentally alert 82 year old mother was brain damaged after having a kidney removed and knew little of her next ten years. Mind you my anesthetist was equally worried when he looked at my ECG/EKG results.

Very chivalrous of you Brits letting the women and children have nappies (aka diapers) but not the men!

I've got a box of mens nappies I bought for my aquablation, but never needed them. Happy to share if you ever need but cant find them in the stores. They sure beat peeing in your pants! We could start a new trend over there. Afterall, you folks gave us the best rock n roll bands ever; the least we Americans can do is share our nappies - LOL!

Your friend who chose the wrong surgeon; I wonder how many other men that surgeon has mutilated with his laser. Even a good surgeon can have an off day. This technology by Procept (Aquabeam mfr) that removes surgeon skill from the equation can be such a game changer.

Your concern about general anesthesia does not fall on deaf ears. I’m so sorry about your mom. What a waste of her precious final years. I avoid general anesthesia whenever possible. My Aquablation was done with propofol and a nerve block. I love that alternative to general anesthesia.

Day 18, a little more frequency yesterday, but today seems much better. No bleeding or RE at present.

Are you still drinking a lot ? Although how much you need depends on the climate where you live.

I must look for a video of a robotic prostate procedure.

The past couple of days 1 to 2 litres, as opposed to 3 to 4 prior. Already noticing less chronic constipation that Ive lived with for many years. Not carrying 400ml post void is giving a bit more room fiwn there, plus water is key to good bowels.

I think something was just irritating my urethra yesterday that caused difficulty feeling empty, making me go hourly. Plus my bladder is still learning. I often feel a little more left after voiding and return to let a small amount (usually, but sometimes 100ml or so) out.

For videos on robotics, google "aquabeam YouTube" and several come up. Cool stuff.

Marty did you said it was pretty pain free after your procedure? I looked back on this thread but could not find anything about that. Was there much pain at any time during recovery? Are you happy with the results?

thanks

Eric,

I wouldn't say painless. I'd call it discomfort. Supposedly, not really different from TURP recovery. Lots of inflammation, so there was a burning sensation when urinating. Nothing that made me want to scream or moan. I'd say it was "wince worthy," but not much more. But, that's my personal experience.

One exception to above: Removing the Foley was not fun! But the related pain is over quickly. Just look at it as a minute out of your life you could have done without.

Yes, I'm still very happy with the results after 3 years. I still have some retention, but flow is good and frequency is vastly improved. I generally get up only 1x per night. I think my results would be better if I didn't have such a tight pelvic floor. I can now live normally, without being in constant search of a toilet.

As I've said previously, look into PAE as a first line procedure. It didn't work for me, but it works for many. Just a thought.

Marty