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Occasionally here Aquablation has been mentioned. I was just reading about it and the reports say it is as effective as HoLEP and there are no reports of retro. Wondering if anyone here has had this procedure and if so how did it work out?
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DooCue tom86211
Edited
My Aquablation Experience
One-month post Aquablation procedure - I can report a satisfactory outcome.
I usually don't post to forums, but since I consulted them so much during six-months of research for BPH treatment, sharing my experience seems like a way to thank others for their posts.
Troubles caused by a swollen prostate developed slowly over several years. I thought I could tough it out. But I was unaware how my bladder was working hard to push through the narrowed urethra, getting thicker and stiffer all the while, unable to hold the normal amount of urine and unable to alert me as it was filling. This stress caused bouts of inflammation. Then, a serious infection pushed me to act.
Only three procedures were suitable to treat my 190-gram prostate. Laser and heat ablation shared risks of disturbing parts of the gland that were not causing problems because the tissue and blood produced during resection interfere with the surgeon's view of the operating field. Retro public laparoscopic simple prostatectomy gives the surgeon the best view but the path of insertion of the surgical instruments exposes the belly, bladder, and bladder neck to injury.
The aquablation procedure is like a CNC milling machine. The surgeon marks out the areas that are to be cut away while visualizing the prostate with ultrasound. This takes about an hour and a half. Once all the margins are entered into the computer, the water jet cutting is guided precisely by the machine. Tissue removal only take a few minutes.
The procedure is done under spinal anesthesia and light sedation. I woke up a few times but couldn't move at all and felt nothing. I heard the surgeon and the team talking quietly. I remember asking “How's it going?" The reply, "By the book," put me quickly back to sleep.
Recovery was somewhat unpleasant. The water jet cutting leads to a lot of bleeding because, unlike laser or heat resection, the blood vessels of the prostate are not cauterized. Although the total volume of blood loss is small, watching it ooze out of the penis, drip onto the floor and pool in bed reminds you that you are in a precarious state.
During this time, I had a very large catheter. It was pulled tightly against the bladder neck and was used to force fluids into the bladder to wash away the blood. I had no pain, but I was, for sure, uncomfortable.
The bleeding stopped after 20 hours. The catheter was removed. But peeing was painful and very difficult. I was disappointed. After another 10 hours of observation and more tests, I was discharged wearing a somewhat smaller catheter. The nurses told me that very few patients were lucky enough to go home without one. I had had previous catheter experiences. They are unpleasant but never painful. On the plus side, they allow you to get a full night's sleep!
I returned after four days. The catheter was removed, and I was peeing quite easily. Ahhh! At first, it was painful and bloody. But everyday brought observable improvements. The urine became yellow and clear. The volume increased. The pain became a tickle. I would wake just once or twice during the night, sometimes not at all. I no longer have sudden urgency. The stream has become strong and the finishes are certain and satisfying. My bladder has felt much more relaxed. My body is no longer battling with itself.After two weeks, I allowed myself erections, and more. Everything is working just as fine as I have come to expect at age 72.
Aquablation was developed about three years ago. So, there are no studies on long-term outcomes. Some surgeons have told me that I might need another procedure in 5-10 years if my prostate continues to grow. Based on my successful experience, I would choose this procedure if I needed similar treatment in the future. I am grateful that insurance covered the costs, which, I am told, would be about $60K without it at the top New York City hospital where the surgeon practiced.
P.S. A week prior to the aquablation, on the surgeon's recommendation, I underwent another procedure – prostatic artery embolization. This involves depositing small beads in the arteries feeding the prostate. This causes the prostate to shrink over time. I don't know yet if that has happened. It's supposed to afford long-lasting improvements. And it may have contributed to less bleeding after the aquablation.
Note: I have no relationship and no contacts whatsoever with Procept BioRobotics.
2019Guy DooCue
Posted
Thanks for that, DooCue. It's a fine and detailed report. I have a friend who had Aquablation about 3 months ago. He had some unpleasant side effects that lasted awhile, but his stream did improve immediately and I think on balance he was glad to have had it done.
$60K though.... wow. I had thought the figure was more in the $25K realm, but maybe that's geography talking. This is a concern for me because, although I am on Medicare, I'm also in the Kaiser system here on the west coast, and they're notoriously stingy about paying for things - especially as I don't believe any of their urologists do this procedure yet so I'd have to go out of network (and likely out of pocket!).
I hope things continue to get better and better for you!
eric56963 DooCue
Edited
Thank you for the thorough report. I wish they could give us something to really numb the pain of going after this procedure. It sounds bloody (and) painful! I tried the itind device. Was a living hell from putting it in to feeling like you got to go almost constantly for six days and when you do it burns like hell. I would never do it again. I dont know if aquablation causes as much pain and for how long while you need to pee after the procedure but I can not imagine it being any worse than what I went through. I had to actually scream out loud every time I tried to pee while the thing was in me and for days afterwards to try to numb out some of the pain.
thomas49738 tom86211
Edited
i just want to go on record saying i had Aquablation two months ago. I had a slow recovery and BPH symptoms are gone. However, I do have a case of retro, and am not pleased about it. My doctor believes its temporary and I will see him again in six weeks. Carefully consider what your getting into. I would say BPH is better that retro
compiler thomas49738
Posted
What was your prostate size before the procedure? Any ongoing BPH symptoms or zero ones after the procedure?
cali-mike1970 thomas49738
Posted
surprising to hear your say BPH is better than retro. What was your IPSS score? what is your age also? That's a bummer that you got retro --I'm told it all comes down to protecting the veru and not the bladder neck (a uro who has done 60+ is telling me that).
james16058 thomas49738
Edited
Thanks for sharing your experience and I wish you a speedy recovery. My understanding is that aquablation is supposed to be retro-free or in other words, bladder neck is spared during the surgery. Has the surgeon done everything correctly?
Please let us know if things improves regarding retro otherwise HOLEP is a better option besides the retro.
michael55618 james16058
Edited
My understanding is that the RE risk is lower than TURP but is not completely eliminated. If you Google 'five year outcomes for Aquablation', I believe the RE risk for Aquablation is about 7%.
eric56963 thomas49738
Posted
where did you get it done?
DougRossbach tom86211
Edited
Hi Tom and the Aquablation Group. I had aquablation surgery 2 days ago and thought it might be helpful to document my experiences. As an intro, I am a 72 Y/O in excellent health other than having an enlarged prostate. I have tried various medications with little success. My prostate was 95cc and I also had consistently elevated PSI (6-7). I suffered from urinary leakage, urgency and frequency that seemed to be getting worse by the month. I tried Flomax but hated the side effects including retrograde ejaculations. I also tried Alfuzosin which seemed to improve urgency but little else. I felt I was getting nowhere with my urologist and then stumbled on aquablation while talking to my GP. He had a client that tried it and was pleased. My urologist did not know about aquablation so I did as much research as possible and ultimately found an amazing doc who is one of the leaders in the field of robotic non-evasive procedure for the prostate. It took months to see the new Uro and several more months while he put me through a battery of test to be sure I was a good candidate and did not have prostate cancer.
I finally had the surgery 2 days ago. I was unconscious for the procedure so there was no pain. The surgery took about an hour. I woke up with a catheter and the usual side effects from anesthesia. As that wore off I definitely had soreness and sensitivity when urinating. I spent a full day in the hospital while they flushed my bladder with 15 liters of water. Lots of bleeding and initially a lot of clotted material. They would not let me be discharged until I was able to produce urine that was free of clots. It is still very red but you can see through it like dark cranberry juice. I was released last night with the catheter which is taking some getting used to. It is uncomfortable but the pain is mostly bearable except I have been having bladder spasms that are painful and take my breath away. They last about a minute. I am currently taking antibiotics, a stool softener, Tramadol (opiod for pain but so far only taken two), PYRIDIUM which is suppose to relieve urinary tract pain, finasteride 5 MG tablet, and alfuzosin 10 MG. Not sure when my follow up visit will happen and they take out the catheter. I have not had a bowel movement yet but hoping for one today.