Aquablation in USA?

Mike, I think you and I were having FLA the same week with Dr K. Mine was three years ago this week.

I think the guy in LA is Mihir Desai. He is at USC and I was given his name by Procept. I have tried contacting them 3 times without any call back from anyone, so I am trying to find someone else to do it. Chicago doesn't sound bad, as we have family in Wisconsin.

I am sure something will work, since I was able to get a year of very good relief, and still better with FLA than before the procedure.

Just a thought. Last I looked, the Procept site did not list all the docs. You may want to ask them which hospitals in your area have the aquabeam robot. Then contact the hospitals to find out the names of urologists using it. Good luck.

Marty,

You are right, most of the doctors mentioned in this thread, and in PM to me are not on the Procept site. I had been in contact with Procept a couple years ago and there was nothing in my area.

I am trying to find someone who will talk with me over the phone, get whatever they need from a local urologist here in Idaho, then just make one trip for a procedure.

Motoman my feeling is whoever does it will want to see you first, Urologists like to do testing the way they feel comfortable because they might not think a particular procedure is best for you. Maybe I'm wrong I will ask if I remember when I see the doc in Chicago in about 10 days.

I agree Mike. I am just hoping to find someone who could deal with it in one trip instead of two.

I need to start making some phone calls to see what the doctors say. Maybe one of them will work with my local urologist?

I'm pretty sure they still use heat to cauterize the bleeders

please message me if still interested i had it just over 3 weeks ago and so far am happy

I have been doing a lot of research on Holep and Aquablation. I would like to talk with you about your experience so far with Aquablation. Please PM me.

Thanks

I am new to this forum. Please explain how you can PM or message someone to speak offline. There does not appear to be a way to do this.

Gary this is Mike588 somehow I got locked out so i created a new profile sorry for delay I will PM you

you should be able to see a picture of an envelope under everyone's name and the word Message in blue just click on that

Private messages have been disabled - I had aquablation just over 4 weeks ago by Dr Kriteman in Atlanta. I think he has done over a 100 by now. One televisit is all I needed to discuss. I had been booked to go with a surgeon in Chicago but they closed for Covid and I got fed up waiting, by the time they opened back up I had already found Dr Kriteman.

I was told it takes 4-6 weeks to heal - I'm able to pee really well now during the day with very low post void residual, at night I'm getting up about 3 times and I was told this should improve over time, the bladder can take 3-4 months to adjust. I tested after 3.5 weeks and no retro but it hurt a lot. The first week I peed like 50 mils with a lot of urgency, second week more like a 100, third week 150 and urgency was less, now between 150 -200 usually, depending on how much I drink and if I wait a bit longer between visits. A couple of times 250 mils so it does seem to continue to improve.

My feeling now is the difference between this and something like Green Light is that it takes longer to heal inside and green light and many others have more chance to cause retro. It was very painful after especially the spasms with the catheter inside. You have to be brave to do this surgery but if you're looking for good results it might be the best option since they are able to map out precisely what tissue to ablate. I was told the chances of retro were extremely low.

I'd be interested to hear from others who have done Aquablation. For me I'm very happy with the results so far. No more Tamsulosin, waiting in bathroom unable to pee or straining, no more self catheters, it's like a new lease on life.

Thanks for posting your experience. I am considering Aquablation because of the mapping and the robotic precision and also HoLEP because it removes most of the prostate, without the need for re-treatment in 10 to 15 years. I’m a healthy 70-year-old, but who knows what condition my body will be like in the future. Both procedures seem to have postop recovery issues. I am fortunate I live in Jacksonville Florida where there is Dr. Kasraeian who has been doing Aquablation since the beginning, for 4 years including trials. I also live near Mayo Clinic where Dr. Dora has performed HoLEP on over a 1000 patients and is obviously an expert in the field.

-> How long did you have to use a catheter postop?

Dr. K. leaves a balloon catheter in the bladder neck for one week and I was told I would experience spasms and a lot of discomfort until it is removed.

-> How much pain did you experience? How bad was it?

-> As part of your procedure did Dr. Kriteman use a balloon catheter in the prosate cavity under compression to control bleeding (this is the preferable way it is now done rather than elecro cauterization)?

-> If so, was this one replaced with a bladder neck catheter?

-> Have you experienced much postop bleeding?

You said you getup 3 times during the night.

-> How often did you get up prior to your procedure?

I usually pee once during the night while on Flomax twice a day.

-> Do you have any postop stress dribbling now when; coughing, laughing, sneezing, running or any exertion which puts pressure (stress) on your bladder, causing you to leak?

-> Do you have any urgency leakage caused by your weekend muscles when you try to hold it in?

I know most men who are sexually active do not want any issues. The benefit Aquablation provides is that it avoids the ejaculatory ducks by creating a harp shaped cutout leaving this area alone. Currently HoLEP cuts this area out completely, thereby causing retrograde ejaculation. I am in the process of questioning some experts who do HoLEP to see if it is possible to leave the ducts alone. One of the reasons I am looking at HoLEP with Moses 2.0 is because the postop recovery is much easier to handle. In theory if retro can be avoided and more tissue is left around the sphincter muscles, then postop recovery could provide the best outcome. I'll let you know what the doctors say.

Hi Gary here are my replies, remember everyone is different!

-> How long did you have to use a catheter postop?

***Typically you do the surgery Thursday morning, stay overnight in hospital one night then take it out Monday morning. If they see a lot of blood they may advise keeping it in longer.

-> How much pain did you experience? How bad was it?

***It doesn’t hurt, just when you have the spasms every 30-60 minutes then it is very bad a ten on a scale of 1-10. I think you could ask for stronger drugs than what they gave me. Maybe Dr Kasraeian has a solution for that?

-> As part of your procedure did Dr. Kriteman use a balloon catheter in the prostate cavity under compression to control bleeding (this is the preferable way it is now done rather than elecro cauterization)?

***I think so, but he did not tell me. That would explain the pain when I had the spasms.

-> If so, was this one replaced with a bladder neck catheter?

***No I mentioned that I asked them to replace and they said they don’t do it any more due to more trauma to prostate. That was a nurse who told me, so I took what she said with a grain of salt.

-> Have you experienced much postop bleeding?

***In the first day and overnight there is a lot of bleeding and they try and flush it out at the hopital. After that, not much, maybe because I had PAE before the blood supply to my prostate is less than for others.

You said you getup 3 times during the night.

-> How often did you get up prior to your procedure?

***Prior to procedure I was doing self catheterization before I went to bed, so it’s hard to compare as I was getting up 2-3 times. Without self cath I am guessing I would have been getting up 6 times. I was told it can take 3-4 months for the bladder to settle down. Another urologist told me it takes 6 months at least. Bear in mind with an obstructed situation you have now the bladder is constantly trying to push. Everyone is different, and whether you do this or Holep I don’t see why it would be any different for your bladder’s recovery.

I usually pee once during the night while on Flomax twice a day.

***Flomax not only causes floppy iris syndrome, and causes retro while you take it, but there are some studies that it can cause dementia. I only learned that recently, and I don’t know how reliable those studies were.

-> Do you have any postop stress dribbling now when; coughing, laughing, sneezing, running or any exertion which puts pressure (stress) on your bladder, causing you to leak?

No - but I wouldn't go running or lift weights until after I've healed so I can't really answer. I'm at 5 week mark almost and feel like I'm just about ready to go back to the gym.

-> Do you have any urgency leakage caused by your weekend muscles when you try to hold it in?

***No leakage, if I try to hold there is some urgency and it's not advisable to do that. I wouldn't say super urgent, kind of normal. Especially at the beginning in the first week if you have to go it’s hard to hold, so you might start peeing the moment you unzip your pants and remove your member so some might hit the floor before you get to aim in the toilet bowl.

I know most men who are sexually active do not want any issues. The benefit Aquablation provides is that it avoids the ejaculatory ducks by creating a harp shaped cutout leaving this area alone. Currently HoLEP cuts this area out completely, thereby causing retrograde ejaculation. I am in the process of questioning some experts who do HoLEP to see if it is possible to leave the ducts alone. One of the reasons I am looking at HoLEP with Moses 2.0 is because the postop recovery is much easier to handle. In theory if retro can be avoided and more tissue is left around the sphincter muscles, then postop recovery could provide the best outcome. I'll let you know what the doctors say.

***My opinion is that HoLEP while recovery is easier surely can’t be THAT easy. So if ejaculation is important to you be prepared for some pain. The worst is the 3-4 days with the foley catheter because of the spasms. Then the next week is bad because of urgency, bit of burning and the spasms continue bit not as bad. The tip of the member hurts from referred pain from prostate especially when the catheter was in. After the first week peeing starts to improve, urgency gradually less, and it will be OK apart from sitting down. You won’t want to sit down for long periods unless in a comfortable recliner or something like that.

Having said all that my experience is not necessarily what someone else would go through. My bladder was damaged from years of BPH. Your bladder may be better or worse and you might not even be a good candidate for Aquablation depending on size and shape of prostate.

Good luck with whatever you choose, one of my friends had Holep and was happy with the results even though he has retro.

Michael, I also had an AQB done by another surgeon with Georgia Urology, Brent Sharpe, last September. Best overall physician I've ever met. He's always been into robotic surgery, believe he was one of the early adopters of the Da Vinci system and now I'm fairly sure Procept considers him one of the top AQB surgeons. When he did my surgery I think he had done around 50 of them so I suspect he's near 100 now. He was the first urologist of many I'd spoken with who, when I asked him how he determines where to set the surgical contours during planning on the workstation said, "it all depends on what the patient wants." Sold.

As you or someone else said though, AQB is different from any other type of urological surgery in that there is very little learning curve. It also helps anxious would be patients to know that Procept always has a trainer in attendance for cases. Kriteman is definitely one of the leaders along with guys like Claus Roerhborn (Dallas area), Dean Elterman (Toronto), the guy at USC in LA, Thurston Bach in Germany and a few others.

I had very little discomfort/pain after the surgery...only when I first woke up in PACU and got in a bit of a panic because I felt a weird pressure in my pelvis which was the pressure of the constant bladder irrigation. My PACU nurse lowered the bag some, let some saline out of the balloon and gave me some pain medication and I was on easy street.

I did experience some bladder spasms when I tried to pee the first time after the catheter was removed 2 days later which turned out to be too soon in my case, but I had anticipated that and got through it. Once the catheter came out and I was able to pass a pee test I've had no issues, including no sexual side effects. The surgery relieved me of chronic pelvic pain I'd been suffering from for a couple of years that became fairly severe in the months leading up to the procedure. That may have been due to my enlarged prostate (mid 70's mls) impinging on some nerves or possibly a stray Urolift clip.

As far as the discussion above about using the foley balloon in the prostatic cavity to control bleeding goes, there is a recently published paper linked to on Procept's web site by one of the researchers that shows how hemostasis has been improved over the course of the past several years by trial and error. You can read it for yourself but in a nutshell, what they discovered was that using the balloon under tension was actually producing worse results in terms of hemostasis. The recommended solution that's been proven to drop the transfusion rate to below 0.8% for all sizes of prostates (some over 300 mls) over the past 2,000 cases is focal cautery in the posterior bladder neck only. Elterman described the process in a recent webinar where after removing the robotic hand piece and using the Toomey syringe (the thing that looks like a Super Soaker) to force out clots, they remove a shallow layer of so-called white fluffy tissue created by the water jet from the posterior bladder neck with a loop. This then exposes any bleeders, as it is this location where lager arteries are found. Once they are located they coagulate them with the loop and then they're done.

I saw where someone else above mentioned that using cautery for that purpose means AQB is not heat free. While that may be true in the narrowest sense, it is a non sequitur in practical terms. The amount of energy used to coagulate is much less than that used to cut and the foot pedal-down time to close those bleeders in the posterior bladder neck area is negligible compared to the amount of thermal energy that would have been absorbed by surrounding tissue had the huge cavity created by the water jet been accomplished using a laser or loop. It's only a minor cost issue since, in effect, doing so requires paying for two disposable surgical instruments instead of one compared to TURP or Green Light.

Overall I'd recommend the procedure to anyone who needs aggressive treatment for BPH with the caveat that you find the right doctor....and that's not necessarily the one who's done the most cases. In my case it was finding one who is very patient focused, listens well, will take all the time you need to answer questions and has a compatible personality.

Thanks Russ for your detailed explanation. I am 13 weeks post surgery. I am still happy with results, the only regret is I didn't do this years ago so my bladder is affected. Still hoping for improvements in that department.