Aquablation Surgery - May 22, 2023

Sorry this is going to be a long post.

On May 22, I had my Aquablation surgery. For background information I am a very physically active 60-year-old with no other underlying conditions. I have been dealing with gradually worsening BPH symptoms for probably the past 7 years. I was not on any medication for BPH or any other medication. The main reason the BPH was detected was an increase in my PSA levels which prompted my GP to send me to a Urologist. The first urologist ordered an MRI which showed an 80 cm prostate with a large median lobe protruding into the bladder. The initial urologist wanted to perform a simple prostatectomy. Upon researching this and the risks, I began the search for a safer and less invasive alternative. After much research and postings from users on this and other sites, I decided that Aquablation was the procedure I wanted to pursue. It was less invasive, had less risks and allowed me to get back to my lifestyle quicker. I found a new urologist and it took approximately 2 months to get his testing done to satisfy the insurance company that the procedure was necessary.

There were no pre-op requirements other than the standard no food or drink after midnight. Arrived at the hospital at 10:00 and moved into surgery at about 12:15. The surgery lasted about 45 minutes and then moved into recovery. Awoke in recovery with no pain due to meds pushed during surgery. The surgery recovery nurses had already started the constant bladder irrigation process. They warned me to make certain that I or whoever was with me to watch the catheter collection bag as well as the bags of sterile water they were using for the irrigation. They said that as soon as the collection bag got about ¾ full, or the irrigation bags got about half empty to notify the floor nurses so that they would be switched out in a timely manner. I thought this was good advice, but foolishly thought it was probably unnecessary for me to monitor this. I would later find out how valuable their advice was.

Moved into a private room by 2:30 and all seemed to still be going well. My pain tolerance is generally very high so when they asked if I needed anything for pain or bladder spasms, I told them no. I honestly had no idea what bladder spasms were when they asked about that. I asked the nurse, and she could not really explain it, but said I would know if I had them, so I decided against any medication. They continued to switch out the irrigation bags about every 45 minutes to an hour and had 2 bags flowing into the catheter at full open speed. I noticed after a couple of hours a feeling of fullness which I didn’t understand since the inbound solution was supposed to be flowing back out the catheter also. This began to be uncomfortable and so I asked for a little bit of pain medication. The pain meds helped to relieve the pressure feeling. About an hour later I had a sudden onset of pain and felt like my bladder was full to capacity and about to explode. Notified nurses of this and by the time they arrived in the room, pressure was even more intense, and I had blood and what appeared to be clots rapidly coming out from around the catheter. This lasted for about 10 minutes and honestly was probably the most intense pain I have ever experienced. None of the nurses seemed too concerned about it nor could they explain what had happened. I thought that it was probably that some debris had just blocked the catheter and it was a one-time event. I WAS WRONG!!!. This situation was repeated about an hour later at which time the nurse called in the charge nurse who said that the catheter probably was clogged and would need flushed. I thought this sounded like a great idea and thought they would immediately proceed, only to learn that they did not have orders from my doctor to flush the catheter so they would have to call him to get the orders. The pressure and pain this time lasted about 20 minutes until it subsided. They managed to locate the doctor and got the orders and flushed the catheter. It was obvious in watching the flush that there was much debris in the catheter. After the flush all was going well again. The charge nurse also said that in addition to the blockage, the pain was probably due to bladder spasms and started the bladder spasm medication. Everything got back to normal after this and the continued with the irrigation. Then a shift change occurred and a new set of nurses came on duty. There appeared to be less nurses on this shift because they were not in the room as often checking on the catheter output bag or the input bags for the flush. I never could see the catheter output bag so I had no way of seeing if it was getting full, but I could see the input bags and they now had 3 of them on the pole so they did not have to switch them out as often. I had finally managed to doze off for a few minutes when I was awakened with the pain and the pouring of blood around the catheter. When I called for assistance this time, they immediately noticed that the catheter collection bag was beyond capacity and so that was what was causing the issue this time. Once the bag was emptied the pain and pressure began to diminish and everything was settled back in about another 5 minutes. They then began to check and empty the catheter bag more frequently. Unfortunately, this function was performed more by an aide who was not the same person who was responsible for hanging the sterile solution for the bladder flush. About 2 hours later, I again felt the pressure and pain increasing and called for the nurse. She arrived and noted that the sterile solution bags were all empty and changed them out. Once the flow started from them, the pain continued to increase rapidly. I explained to her that they had flushed the catheter previously and this helped. After getting the right supplies the flush was performed and they found that the catheter was definitely blocked. They said that this was probably caused by the inbound flow stopping when the bags ran out. Everything was restarted and everything was good for the remainder of the night with no further spasms or blockages.

The doctor made rounds the morning after the surgery at around 7:30 and said all looked good as far as the color of the discharge so he was going to discharge me. He does not remove the catheter until 3 days post procedure, so I was sent home with a catheter and told to make an appointment for Thursday to have it removed. I arrived home and settled in by 10:30 and thought I was finally going to get some rest. I managed to fall asleep for about 3 hours when I woke up again with the pain and pressure. This passed in about 15 minutes. I felt that again it was due to a combination of the bladder spasms and debris blocking the catheter. I did not want to call the doctor and have to go back to the hospital, so I checked online medical videos and found several videos where doctors were instructing patients how to flush their own catheters. Fortunately, there is a medical supply store close to my house, so my wife was able to go and get the necessary supplies. When she returned, I flushed the catheter, and all was good for the rest of the afternoon. When I woke up later that night to take medications, I felt the pressure building again so I flushed it before it got to the pain point. I had to do this a couple of times more before the catheter was removed on Thursday, but these were all preemptive instead of waiting until the rush of blood etc.

Thursday afternoon I had an appointment to get the catheter removed. I thought it would require drinking water and then seeing if I could pee, but it did not entail me drinking. I arrived at the doctor’s office and the nurse said she was going to take a syringe and fill up my bladder and I should tell her when I felt like it was full and I needed to pee. She then placed several syringes of saline into the bladder until I told her it was at capacity. She then told me she was going to remove the syringe and the catheter, but for me not to pee until she told me to. The removal of the catheter was not painful. She then gave me a container to void in. Voiding went well, not the gush some people reported they have immediately, but a decent stream. After voiding, she said that I had passed because I had voided almost all of what she had placed into the bladder. The doctor came in and verified the void amount and said that he would see me in about 3 weeks. Said the main thing was to drink lots of fluids to continue flushing the bladder and to finish the antibiotic.

Arrived home and continued to drink plenty of water and Gatorade. Frequency was still there as well as a few bouts of urgency. I probably drank too much in hindsight but was concerned about not drinking enough. I went to bed that night and got up about every 2 hours. The steam initially was good, and I did drink more water after every trip to the restroom. When I woke up around 6:30 I found that the urgency was definitely there, but the stream was now very small and painful when I attempted to pee. I became concerned that if I called the doctor, it would mean a new catheter. I thought that maybe it was just a blood clot and if I moved around it would cause it to discharge. I walked around inside my house for about an hour during which time I stopped several times to pee. With each of these times the stream seemed to only get slightly better but still nowhere close to what I had the previous evening. I then remembered reading in someone’s prior postings about experiencing a similar situation and they took an ibuprofen and tried to pee again in about an hour and it had worked for them. I took an ibuprofen and one tadalafil tablet since this had initially been prescribed by my first urologist to relax the muscles to help urinate. Within the hour, I noticed that the stream began to increase and was back to the same flow as the previous day. The flow the rest of the day remained fine, and I went for a walk and walked for 3 miles. I tapered back my fluid intake after 8 PM that night and managed to sleep for 4 hours before I had to get up the first time.

Saturday morning was day 5 post surgery and day 2 post catheter. I have switched over to taking only regular Tylenol for pain and have discontinued taking the bladder anti-spasm medication since it was causing extreme dryness in throat and nasal passages. The stream is still staying the same and frequency and urgency seem to be improving. Still passing a few blood clots at times and taking Azo for the burning during urination. Walked 3 miles again today.

Sunday morning. My sleep last night was good. Slept for 6 ½ hours before waking up. I was able to pee quickly and go right back to sleep. No major differences today from Saturday.

Monday morning it has been a week now. I slept for about 6 hours tonight uninterrupted. I have discontinued all medications. There is an occasional burning sensation when passing a clot/scab or peeing afterwards, but not bad. Stream continues to see minimal improvement which fluctuates some prior to passing of a clot/scab. Urgency is almost non-existent. Frequency during the day is really hard to assess since I am currently drinking more water than I have in years. Even with the high volume of water, I am still able to wait an hour to 1 ½ hours before needing to pee.

I must say that even though the first 4 days were somewhat rough, so far, I am extremely happy with the results and have no regrets about having the procedure. I am HOPEFUL that I will get to resume running after week 2. Initially my doctor had said 2 weeks for running and 4 weeks minimum for biking. The day of surgery he told my wife 4 weeks for running due to having to spend a little more time on the median lobe. However, the next morning when we discussed it he said we would evaluate it as we got closer to the 2 week mark. I will continue to update this information as my recovery continues. I know that the information that was online here helped me tremendously as I was deciding on the procedure and perhaps more importantly giving me real life experiences of the procedure and the outcomes. Let me know if you have any questions.

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