New prostate BPH procedure called Aquablation
Posted , 22 users are following.
There is a new surgical procedure for BPH called Aquablation - FDA approved in the USA this year. I had it done ten days ago. After decades of suffering, I am already feeling the benefits of a normal happy bladder. I can finally empty, have a strong stream and go for three to six hours between feeling any need to urinate. Still a trickle of blood comes out once in a while, so I am still healing. Its only been ten days!
Aquablation uses high velocity saline water jets to remove prostate tissue with the "Aquabeam" robot. No heat, vapor, laser, hardware left in prostate, etc. Same outcome as TURP without sexual side effects or long recovery.
My advice to BPH sufferers seeking an effective procedure: no large median lobe, consider doing PAE (I had mine done several years ago, but my large median lobe remained a problem); otherwise, consider doing an Aquablation. Google it!
Anyone else out there who has had an Aquablation?
0 likes, 37 replies
dantec Marty02
Posted
You mentioned you have BCBS for insurance which approved coverage. Is that your primary insurance or are you on medicare with BCBS being your supplemental?
Marty02 dantec
Posted
Primary. Im not on Medicare. Also, it was New York States "Empire BCBS."
russ_777 Marty02
Posted
The big benefit with this is supposed to be the short amount of time during which the ablation occurs. Think I read 5-6 minutes in some cases. This is compared to a minimum of 30 minutes for a TURP on a decent sized prostate.
Do you know if they waited to put you out until after the Dr had done the mapping part? Or was the entire thing under anesthesia?
Marty02 russ_777
Posted
Yes, it is true that the time you need to be under is minimal because the robot gets things done quickly. I was put out with propofol (before mapping was done) and given a spinal nerve block for my lower body. No general anesthesia. Technically, they could have skipped the propofol and kept me awake.
As far as benefits of this procedure, the following is how I see it:
Benefit 1: Aquablation is done using the “Aquabeam” robot. The computer controls the location and the depth of each cut based on the mapping done by urologist. This unique precision cutting is not reliant on the skill or steady hand of a surgeon. As long as your urologist knows prostate anatomy and how to read a ultrasound, he can give you the procedure of a top notch surgeon.
Benefit 2: No heat, laser, vapor. Just high velocity computer controlled cool saline jets are used to cut and remove prostate tissue. Vapor/heat based procedures, such as Rezum, are more prone to unintentionally damage surrounding tissue.
Benefit 3: TURP like outcomes with reduced chance of RE or ED. Studies show Aquablation causes virtually none of latter and has about a 15% chance of former. I have read more and less chance of RE, but nothing close to TURP or HoLEP.
Benefit 4: Faster recovery than many other procedures. Cuts heal faster and neater than burns.
Benefit 5: Ability to fully target median lobe. If you don’t have a median lobe issue, I think you should consider doing PAE first. In fact, like I did, you may want to give PAE a crack regardless. PAE can be effective with some median lobes. Talk to your doctor.
Benefit 6: No straps or hardware is left in the body as with the Urolift. I know people are told only some of the Urolift hardware can’t be removed, but I believe the prostate can grow around all the hardware. I was unable to get comfortable with leaving anything behind, although the simplicity of the Urolift procedure is very appealing.
That’s all I can come up with at the moment. I hope this is useful.
Marty02 russ_777
Posted
Regarding the mapping issue, my understanding is that the urologist targets blockages on a real time ultrasound that is part of the robot. He is not mapping on a static picture of your prostate.
Once the urologist has targeted the areas of concern on the real time ultrasound screen, the robot takes it from there, automatically deciding how much jet pressure is required for each cut and how to do each cut.
My urologist knew that if the ultrasound revealed a marginal choice, I preferred a slower stream to RE. Regardless, there are no guarantees.
I cant read an ultrasound and don't see why I needed to be awake.
Marty02
Posted
I would be interested to hear from anyone who is unhappy with their aquablation as I am only reading about success stories.
I am on the 12th day of my recovery. I stopped peeing blood on the 9th day. No more burning since the 6th day. No cath since the 2nd day. A strong stream since the 2nd day. I AM NORMAL AGAIN after decades with BPH. Normal ejaculation - no RE (yet). I'm getting up no more than once a night. My aquablation is thus far a total success! Could this be a typical outcome?
If it is, I want everyone to know.
TNVA Marty02
Posted
Good to hear of your success with Aquablation.
Any information on it's effectiveness for large prostates, say over 100 up to 200 gm?
For the PAE median lobe matter, Dr I. from UNC informed me a couple weeks ago that large median lobes on generally large prostates was not a problem and that a study of this would be in the next issue of a related professional journal. Sorry, I did not catch the name of the journal.
Marty02 TNVA
Posted
Quote from web Renal and Urology News:
"Aquablation Effective for BPH Despite Large Prostates - Renal and Urology News
May 3, 2019 · “Aquablation is effective independent of prostate size and clinically normalizes outcomes between patients with a 30 cc to 80 cc prostate and patients with an 80 cc to 150 cc prostate treated for lower urinary tract symptoms due to BPH with an expected increase in the risk of complications,” Dr Nguyen told Renal & ..."
That being said, as pleased as I am with my Aquablation (so far), I would definitely give PAE a try first if there is a chance it can fix a problematic median lobe.
emmanuel43036 Marty02
Posted
This seems to pot the maximum prostate size it can handle at 150cc?
Marty02 emmanuel43036
Posted
Or that was the largest prostate they happened to have in the study. The "Water II" study is shown on the manufacturer's website (Procept-Biorobotics). It doesn't say anything about over 150cc.
oldbuzzard Marty02
Posted
The rap on aquablation is that while the procedure is way shorter, less invasive with fewer side effects than TURP with similar results, the recovery is often as long or longer. In many men, the bleeding doesn't stop for 3-4 months. So this isn't usually the ideal first option for simple BPH.
Marty02 oldbuzzard
Posted
I agree. PAE was and is my first choice.
This bleeding issue. I see nothing mentioned in studies but that doesnt mean it doesnt happen. I'm on day 15 (not day 12 as i said above). Bleeding stopped on day 9 and, after I read your reply, a trickle of blood (teaspoon) came out at the end of my urination (thanks for jinxing me).
If thats the kind of bleeding people have for several months, I'll take it over, for example, doing caths for many months. There is no pain associated with it. It is just the bleeding of a healing wound on moving tissue.
If, on the other hand, you are talking about severe bleeding, I would think this is an outlier event, or the result of doing the procedure on patients who have conditions that prevent clotting, but maybe Im wrong. That I would be amazed was omitted from the studies that went before the FDA. IMO.
Marty02
Posted
Update: Visited my Urologist today for first post Aquablation follow up (3 weeks). Ultrasound revealed post void volume was negligible, whereas pre Aquablation PVV averaged 400cc.
Although my frequency is way down (day and night) and my flow is very good, I occasionally get a feeling in my penis that I still have to go after voiding. Urologist says this post void sensation is common and will go away after 60 days. Bleeding seems to be gone, but he says to expect a spurt now and then for four months. I am having ultrasound done next week to see how things look in there (prostate, kidneys, etc).
Uro is highly skilled/experienced HoLEP surgeon and says Aquablation procedure is amazingly simple to perform. He still does HoLEP - a procedure that requires a high degree of skill - for patients that are not good candidates for Aquablation.
Dogcajunatyahoo Marty02
Posted
Hi Marty, checking in with you to inquire of your progress. 69 Yold here w BPH w infections with bleeding; CT in July show P at 220ml; Exploring options; Latest interest is ThuLEP - Thulium Laser for large P up to 300ml; Challenging but has been done. HoLEP is different type of laser for not so large P. How big size can Aquablation handle. I am in the fact - experiences - how long successful mode of querrying right now. Normally only get up once during night -1 or 2 days a week; Rest of time I can wait until wake up time from 5-7am; My big issue is the infections with bleeding. So, 2020, I hope to address this someway... Ps. No cancer per CT n DREs - just a large dam P.
Marty02 Dogcajunatyahoo
Posted
Dogcajun,
None of the studies or information I have seen suggest a P size limit. That being said, I have not seen a study that involved more than a 150ml P. I think the concern rests more with the structure of your prostate. This is something a uro has to decide.
I am now 2 months post aquablation. I remain very impressed. I have very strong stream (best in my life, actually), no bleeding, and I completely empty. No RE yet.
There is an occasional irritation in my Urethra that makes me feel the need to pee a little more after emptying, but that seems to be getting less frequent. Doc says its probably residual inflamation.
Also, if Im constipated that increases frequency - I think this is normal for some people. Otherwise, I go every 3 to 5 hours, typically.
This procedure has given me my life back. My P size was only about 60cc pre-op. Median lobe was my conundrum. I did not have any infection or bleeding pre-op. I dont know if the latter would preclude aquablation.
There is a help desk at Procept (phone number is on their website), the MFR of Aquabeam robot. They may give you better information.
Marty
Dogcajunatyahoo Marty02
Posted
TU Marty....
dantec Dogcajunatyahoo
Posted
I am having a holep in a week by the same doctor that Marty used for aquablation. When I asked the doctor about aquablation he said he didn't think it was appropriate for me because I have prostatitis and bph (about 76cc size). He says he has had luck with holep on people with prostatitis. Holep removes more tissue than aquablation which he feels is important for someone with concomittant prostatitis. I sent you an article about a case study where they did holep on someone with a 400cc prostate. Not sure if you saw it.
Dogcajunatyahoo dantec
Posted
i did read it. Dr i contacted in chicago advises that ThuLEP has been done up to 300g. From what i read Thu has better results than Ho. I think it is all about the different type of laser. I am comtemplating a consult visit in Chicago. They also do Single Port Robotic Simple P surgery. So y are doing HoLep - right?
joe74831 dantec
Posted
Hey Dan please keep us fellow prostatitis sufferers informed after you have this procedure. This is the first time I have read that this might help . Like you I have a fairly small prostate, 46 cc but lots of issues, including chronic prostatitis.
Do you happen to know if there are any studies showing its effectiveness?
Any results good or bad will be appreciated, and really wish you great luck.
Joe
Dogcajunatyahoo dantec
Posted
Best to you n a speedy, successful recovery! Lots of fellas rooting for you.....
dantec Dogcajunatyahoo
Posted
Yes I'm having holep done.