Had my Aquablation yesterday - initial thoughts

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Hello everyone. I've been reading and posting here ever since I started doing a deep dive into the more aggressive BPH therapies a couple years ago. Brief history - I had a Urolift 4 years ago almost to the day. 5 clips in lateral lobes and it worked quite well for the first 2 years. My regular there different urologists told me in no uncertain terms I needed more aggressive treatment which is what TURP/GLL/HoLEP are for. Interspersed along the last two years I had to have lesions on my bladder wall biopsied twice - both times negative for malignancy. Then in the past 6 months I began having significant pain and burning in my pelvis. That was what pushed me over the edge.

After reading dozens of published papers on BPH, prostate anatomy, sexual function, and randomized controlled trials of newer technologies and talking with reps from the companies who developed the newer technologies I decided aquabation was the best option for me. I had it done by one of the two urologists in the Georgia Urology practice in the greater Atlanta area. There was only one other practice in the south east that had the aquabeam system so I went with the one closest to some relatives in case I needed some additional help.

I self-payed since my insurance has not covered it yet (but should fairly soon). Hospital charge with mandatory one night stay-over was $7k and some change after the 75% self pay discount was given. Can't say enough good things about Northside Forsyth Hospital where I had the surgery done. Including the surgeon's and anesthesiologist's fees it was about $10k.

The anesthesiology department had planned on using a spinal to number the lower body and some propofol so that I could sleep through it. However the induction depth was not going to the level of GA where you have to have your breathing assisted. My surgeon had them ditch the spinal in favor of general to make sure there would be no movement during the procedure. This is important for aquablations since any movement would throw off the alignment and calibration of the hand piece and/or the rectal ultrasound probe. They gave me some pepsid to lessen the chance of any residual stomach content aspiration during pre-op and also some versed to relax me before getting rolled back to the OR.

The last thing I remember before the anesthesiologist induced me was noticing how crowded the OR was and of course sliding over from the Pre-op bed to the table. I had barely settled in on the table when he dripped the propofol.

I woke up in post op recovery and had a pretty rough time for 30 - 45 minutes with pain that I assume was from bladder spasms. Fortunately the post-op nurse gave me a suppository for the bladder cramps an I think also some more pain medication. Once I got past that I'd say things went pretty smoothly. The hospital has what they call the 23 hour floor which is for outpatient surgery patients which is where I went next. One curious thing my surgeon told my wife after he finished was that he was able to find and remove only 3 of the 5 Urolift clips. That's a little concerning. It's not like the waterjet left much tissue behind in the areas other than the masks he set up for the bladder neck and verumontanum.

There's not a whole lot to say about the results yet until I get the Foley removed tomorrow. Because of the nature of the aquabeam system and the surgical planing process the surgeon can implement ablation maps that, in his words, create an Autobahn or a single lane dirt road. I opted for the latter since I wanted to minimize the risk of anejaculation.He said other patients don't care about that, they just want as much tissue removed as possible.

I have noticed that the pelvic pain I had been struggling with for months was gone...so that in and of itself is a win. Otherwise I'm dealing with the bladder spasms and have been hauling around a bag full of pink-reddish irrigation solution they pumped through me all day yesterday and until I left today around noon. By my count they ran ~25 liters of saline solution through the foley and back out. The foley was also under mild traction for about 4 hours post-op. Getting that released was a relief.

I'll post updates on recovery status as I make progress. As far as any sexual side effects are concerned, I will not be the least bit regretful if my pre-op function doesn't totally return over the next few months. Getting rid of constant pain and discomfort that affected my lifestyle greatly became my #1 objective, far ahead of any potential sexual side effects.

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  • Posted

    Hi Russ, I'm a couple of days behind you. I go in for my Button Plasma TURP tomorrow afternoon. I had a failed Urolift in 2015 and I think that I have 4 clips and I'm hopeful that they can shear them but my urologist/surgeon said that sometimes they can be buried in the skin pretty deep. My understanding is that the Urolift clips that are anchored on the external part of the prostate capsule cannot be removed to so the best that can be done is to shear them so that they release the interior lobes. So someone would still be left with those external anchors but most of the wire that connects to the interior lobe and pulls it back will be gone. At least that is what my doctor told me and she has operated on guys with clips before. I really like and trust my doctor which was not the case in my previous procedure and I'm looking forward to getting my median lobe off of my bladder outlet. I think my bladder function is pretty good, at least according to the Urodynamics test, but we'll take it one step at a time and step one is removing that median lobe obstruction.

    I'll be on the 23 hour plan as well and well irrigated during that time and my doctor said that they usually send folks home without a catheter but that will depend on what they see in the bag in terms of clots, tissue, viscosity. I was a on a Foley for a couple of days following the Urolift and while it was a little awkward I didn't think it was the end of the world so if I come home with a Foley for a few days, no big deal. In a way it's ok as you don't have to worry about retention/blockage for the first few days.

    I had a full workup for Aquablation at USC but was told that it was not the best option for me because of my low platelet count and concerns over bleeding.

    The bladder spasms suck but hopefully they calm down soon for you. Hang in there.

    Rob

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    • Posted

      Today was 2 weeks post surgery and it was an eventful day (in a good way). I ended up having more difficulty with swelling than I anticipated and failed my first two pee tests after the Foley was removed 2 days after surgery and then again 8 days after. It was not a pleasant experience to get rid of the catheter twice only to have to have it put back in a few hours later. But mostly a nuisance having the catheter and bag to lug around and frustration when I stood there with my bladder squeezing but not a drop coming out.

      So this morning, exactly 2 weeks post surgery, was the third attempt. Third time's a charm --- right? You bet! This time the nurse injected water into my bladder via the Foley just before pulling it out instead of sending me home to drink a bunch of water and try to pee at home. She said she could put in as much as I wanted but I felt enough urge at around 250 ml to say "whoa." I was fairly confident I'd be able to get it out this time because my uro suggested I start taking Alleve/Naproxin after the 2nd failed pee test to reduce inflammation. The trade off is if you're bleeding the Alleve can make it harder to clot. But as the week went on I started feeling a lot better which I attributed to reduced inflammation. So the nurse had barely left the room after handing me a plastic urinal when that glorious sound of pee hitting the bottom of the urinal I was holding signified victory. I peed out every drop she put in all in one continuous stream, no hesitation, no start/stop, no pain/burning, no dribbling at the end. What was strange was when the stream finished I've been so conditioned to forcing a few final squirts out at the end I instinctively squeezed, but nothing came out. Totally weird feeling, but a great one!

      It's been about 12 hours since I had the catheter removed and I've peed about 4 times, not as forceful as the first time when all the water was injected into my bladder, but still at a decent rate (I'm guesstimating I was doing close to 20 ml/sec at the doc's office). I did have some dribbling at the end the last two times but it was very different from what I'd experienced the past few years. Just had to wait about 10 seconds while gravity let the last few mls drip out under no pressure from my bladder. I sense my bladder is trying to figure out what the hell is going on. Of course it's been almost completely inactive for 2 weeks so that isn't surprising.

      The reason it took me two weeks to get rid of the Foley is probably because my surgeon, at my request, was very conservative in removing tissue around the veru. That or the bladder neck is probably where it was swollen shut.

      So I feel great but understand I need to take it easy for a few weeks. Neither my surgeon nor my regular uro said anything about when they would green light me for any sexual activity. I'm guessing 3-4 weeks is reasonable but I'll get that from them early next week. I would add that a few times I struggled when I inadvertently started getting erections with the catheter in...lol. Didn't get close to the flag being fully hoisted but like some others have said I was surprised that one of the side effects of the surgery seems to be recovering some of the libido I'd lost the past few years. As I'd mentioned in the initial post above, I noticed within the first 24 hours that the persistent pelvic pain I'd been suffering from for 2 years was gone. I'm guessing the increased libido is related to that.

      Despite the minor setbacks I'm a happy damn camper. No one should ever assume recovery from prostate surgery will be easy....it's all about managing expectations and not allowing yourself to get too frustrated. It remains to be seen if I'll get RE but honestly, now that I'm on the other side of it and all of that chronic pain is gone, that will be very easy to accept if it happens.

      I'll continue to update as conditions warrant.

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    • Posted

      Coming up on 4 weeks post surgery. Everything has pretty much normalized. I still haven't measured my max flow rate but believe it to be in the upper teens (ml/sec) which is excellent. My bladder/brain still seems to be adjusting to the new normal in that it usually takes a few seconds for my sphincter(s) to open up. But basically, I'm able to go 3-5 hours with no urgency but typically go every 3 hours, do not get up at night at all and as I keep saying the persistent pelvic pain I had which my docs assumed was CPPS is completely gone. I said above I would not be bothered if I had RE since the overall improvements are so wonderful. I'm happy to say that everything is working OK there too. It may be my imagination but the overall experience seems more pleasurable and intense. So I think my search for the best procedure/doc for me paid off.

      The only things I've been advised to avoid at this point are bike riding and strenuous lifting/squatting. In another 2-4 weeks I'll have a cysto to make sure the two urolift clips he couldn't account for aren't exposed. At that point I should be done with urologists, hopefully for years.

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    • Posted

      Hey Russ, congrats on the recovery process and continuing improvements in your BPH/LUTS symptoms! After significant research the past few years, I'm strongly leaning towards Aquablation and have spoken to a couple of Uro's that perform the procedure. Would love to get some more info on who your Uro was, I have a hunch I know but will send you a PM to confirm. Thanks for all the helpful feedback above and best wishes for continued improvement/success!!! Steve

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    • Posted

      I can't answer that question for you because I've never had Rezum and I didn't have your exact issues. It's very dependent on what your issues are and what your objectives are.

      Some generalizations are:

      • Aquablation will be more expensive
      • Aquablation will require an overnight hospital stay and Rezum won't
      • Easier to find uros who do Rezum
      • Without proper anesthesia many say Rezum can be very painful; no pain with Aquablation due to GA
      • If you have contraindications against general anesthesia and spinal anesthesia then Rezum may be the only choice between the two
      • Aquablation allows very precise control of what tissue is removed
      • Neither requires much surgical skill
      • No heat involved with Aquablation - less chance for collateral damage
      • Aquablation is easy for surgeon to tailor to desires of patient (max flow-vs-normal ejaculation)
      • Aquablation is more likely to have an immediate improvement in LUTS since it removes tissue during the procedure
      • Very small chance of needing transfusion with Aquablation, none with Rezum
      • Aquablation can treat the bladder neck and the protruding part of a median lobe, Rezum has a proximal limit on injections (believe it's 1 cm South of bladder neck).
      • As the ejaculatory ducts run through the median lobe/central zone of prostate, the cell death caused by a steam injection in the median lobe may pose a risk to them
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