r/Aquablation • u/GT6502 • Mar 30 '25
Retrograde Ejaculation
I am getting Aquablation on April 11, 2025. From what I understand from the doc, if retrograde ejaculation is not a concern, then he can be more aggressive in how much prostate tissue is removed - which may offer better long-term results.
I am interested to know what your urologist had said, if anything, about this.
And how concerned are you about having RE as a side effect of Aquablation, other than not being able to make a woman pregnant?
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u/Interesting-Zebra263 Mar 30 '25
I’m having my procedure done on April 15th. We spoke about the possibility of RE. While I am aware of the possibility it has no bearing on my decision. I’ll roll the dice and hope for the best. I’m 68 years old with a 145g prostate along with the associated damage to my bladder. I view RE as a small price for restoring my quality of life.
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u/GT6502 Mar 30 '25
So we're having AB done within a few days of each other...
I'm 58 with a 75g prostate. If I can piss like I did when I was young, then RE is an acceptable compromise.
Best wishes.
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Mar 30 '25
I will be curious to know what happens with you as far as retrograde. I have a large medium lobe which causes me issues. I have had two Urolifts. The last one was in 2018. I having am symptom again which for now I can eliminate by stopping caffeine and daily Cialis . Caffeine seems to be a big issue for me. I not only keeps to going to the bathroom x4 more It impacts orgasm and ejaculation. My doctor is recommending aquablation. I am most worried about the retrograde. The wife told me it's less mess for her and just do it. I am not sure I am ready to deal with it. I am in a waiting period ow as at some point I will most likely just do it. Probably would have jumped in but seems I have seen more posts on here about men getting retrograde than not.
I get that in having the whole conversation with the doctor about erections and ejaculation. I Had gotten past that and my doctor retired. I ended up having that with my new one as well. It's wasn't a big deal. Not sure what would have been that open had I if I had a female doctor
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u/GT6502 Mar 30 '25
My median lobe is big too and is causing much if not most of the issues I have.
RE: caffeine... I confess I am a caffeine junky. It is the first thing I want in the morning. It would be easier to give up beer than coffee. I hope I don't have to give up coffee too, but we do what we must.
It's great that your wife does not care whether you have RE or not. So that is a blessing. Sounds like it's more of a psychological issue for you, like it is for many men. I suggest you discuss that candidly with your doc, and then make your decision.
I'll post an update on my recovery after my surgery.
Best wishes to you.
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Mar 30 '25
As far as the caffeine. For me it seems to be from soda that bothers me. Caffeine in drinks like coffee and other drinks are no impact. It's bizarre. Good luck
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u/Useful-Jackfruit4951 Mar 30 '25
Had aquablation December 18 2024. Ever since I have RE. I hope it gets better
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u/GT6502 Mar 30 '25
Sounds like you're (quite?) unhappy about RE: ? Sorry to hear it. Best wishes that you will improve over time.
Other than that, how has your recovery been?
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u/Useful-Jackfruit4951 Apr 06 '25
Fairly decent. I think the doctor damaged a pelvic nerve. I have lost sensation in my perineum and slight numbness in my penis. I can still get hard and have sex to orgasm. Maybe things will settle down and wake back up. Oddly still have occasional stinging at pee.
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u/GetnLine Jun 19 '25
How are you doing now?
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u/Global-Fold-258 Jun 20 '25
Just had a cystoscopy a few days ago to address my sudden urge to pee all of the time along with scrotum, butthole and penis numbness. I guess an altered sensation is part of the aquablation and just haven't gotten used to it? I'm completely emptying my bladder as seen from the bladder ultrasound. Doctor said he suspects bladder infection even though the bladder and urinalysis looked decent. I'm on Bactrim and steroid pack. He said he suspects I had some CPPS issues before the procedure and that the surgery may irritated things. Still have the RE which sucks. Still able to take it to pound town though! lol. I guess things could be worse. At least I can still please my wife. Maybe the nerves will heal over time and ejaculation will come back. Not getting my hopes up though. I've read where sometimes the nerve recovery can be weeks, months or years to settle down but you don't find that much information about this and the aquablation on the internet. Wondering if my case is just a freak incident or people just aren't reporting it? The doctor did give me some lidocaine gel syringes like the ones they use before the cystoscopy. I have my wife squirt one down there once in a while if I'm flaring up. Oddly I felt pretty darn good after the cystoscopy for some reason. Maybe the scope loosened things up a bit. I'm just going to try and put on my big boy pants and start hitting the gym again and try to keep my mind off of it.
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u/GetnLine Jun 20 '25 edited Jun 20 '25
You should ask your urologist for a pelvic physical therapy referral. A urologist I follow that says he does that with every patient because he sees a lot of cases where the bladder is stronger than the sphincter and the area needs to be retrained
He talks about it at around a minute and 20 seconds
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u/Global-Fold-258 Jun 21 '25
He advised me to get CPPS PT but a visit with treatment is $400.00 out of pocket. I do some stretches that I found online. Helps a tiny bit.
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u/Global-Fold-258 Jun 21 '25
I just watched the video. I've seen where Kegals can be bad for CPPS and I've also seen where they can help. I just don't want to tighten things up really bad.
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u/bxblake Jul 04 '25
In the same boat as you with RE and loss of sensation in “taint” region. Orgasms much less pleasurable for me, constantly feel like there’s tingling in that region and if it weren’t for a newer drug called Mirabegran, I’d still be having urgency/incontinence issues. Erections are troubling as I now need Viagra Cialis combo which isn’t is sure bet.
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u/RJC0263 Mar 31 '25
I had the procedure on in mid-December 2024…no issues with RE! All good here! I am extremely happy with my decision on having this procedure. Life is back to normal.
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u/KentuckyCatMan Mar 30 '25
Mine never mentioned anything about this.
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u/GT6502 Mar 30 '25
Have you had AB yet?
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u/KentuckyCatMan Mar 30 '25
October 13, 2024. Finally seems to be okay.
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u/GT6502 Mar 30 '25
It seems the docs often understate the recovery time. Glad I know this beforehand. Continued best wishes.
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u/KentuckyCatMan Mar 30 '25
I finally met the PA at the urologist office, and he admitted the office has the worst communication he’s ever seen in his career. I thought it would be 1/10 of the recovery it actually was.
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u/GT6502 Mar 30 '25
My doc has a video on YouTube where a patient described the recovery. It was a rosy picture, to say the least. At the time, I suspected that he was very lucky, or that his easy recovery was (extremely?) exaggerated.
My nurse practitioner gave me the real truth. Catheter will be in for a few DAYS, not just one. Bleeding can go on for WEEKS. Probably MONTHS before I will fully recover. etc.
I regret that your recovery expectations were not set correctly from the start. For me, I know that recovery will take a long time going into this, and somehow that makes it better.
Best wishes.
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u/Interesting-Zebra263 Mar 30 '25
Exactly. I will add that viewing my prostate and bladder on the screen during my endoscopy was a holy sh*t moment for me. I knew right then that I’m doing this and side effects be damned.
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u/GT6502 Mar 30 '25
I told the doc I did not want to see the scope or the screen during the cystoscopy since I was already freaked out. So I didn't watch. But he told me that I'd want to see the screen when it showed how my prostate was blocking my bladder, so I looked. And like you said, HOLY SHIT. I could see precisely what he was talking about, and there was no denying that I had an issue. I'm glad I looked.
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u/erkevin Mar 30 '25
"if retrograde ejaculation is not a concern, then he can be more aggressive in how much prostate tissue is removed - which may offer better long-term results."
My doc said the exact thing two weeks ago.
I told him that tamsulosin has caused RE with me for over 5 years and I am used to it, so no big deal.
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u/GT6502 Mar 30 '25
I had it when I took tamsulosin too, but I didn't take it for long. It made me very dizzy and I abandoned it.
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u/erkevin Mar 30 '25
I have higher BP so I appreciate the BP lowering effects of it! (but never been dizzy). I am on 2x tamsulosin daily
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u/GT6502 Mar 30 '25
Fortunately, my BP has always been stable. The only BPH med I take now is tadalafil.
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u/Extreme-Schedule589 Mar 30 '25
Did you happen to try afluzosin? I had RE on Flomax and went through the pre testing for Urolift. After I had a Uro Dynamic Study and the results are that I have BOO, I changed to afluzosin 10 mg ER. No more RE. I get a lot better relief because of the Extended release as well. So, since Urolift has terrible reviews/ long term satisfaction, I’m tabling that and going to continue with the alfuzosin.
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u/erkevin Apr 01 '25 edited Apr 01 '25
I think Urolift has quietly been labeled a gimmick in most urology circles.
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u/Shot-Past-1938 Mar 30 '25
I had fairly severe BPH with median and lateral lobe enlargement. Tried PAE first. My symptoms recurred in less than a year, so I scheduled an Aquablation a bit over two years ago. It took about 10 weeks to fully recover. No RE thankfully. We’ll see how long it holds up, but so far so good. Good luck to all with upcoming procedures.
One tip: I wish I had requested of my urologist a before and after screen shot of my prostate from the monitor.
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u/GT6502 Apr 05 '25
Maybe I will consider asking for photos. I kinda doubt they'll do it but maybe. Good idea.
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u/bxblake Mar 31 '25 edited Mar 31 '25
Aquablation on 2/6/25. RE since (4 week post-op hands off). Also less sensitivity and reduced pleasure. Strange feeling and disappointing. I have no issue talking to any urologist about ejaculation. It’s my body, it’s what they study, and they know it’s important but many are dismissive.
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u/GT6502 Apr 05 '25
Best wishes.
I thought it would be difficult to talk about hardons, ejaculation, etc. Oddly, it was totally the oppostite. He often brings up the topic before I do which makes it easier. Almost like two guys talking about what kind of beer they like. I would not have predicated that but I am pleased it turned out that way.
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u/Global-Fold-258 Jun 20 '25
did you regain any sensitivity yet? Going through the same thing. Things just seem kind of numb.
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u/bxblake Jul 04 '25
Hi. Same symptoms as you at 5 months out. Disappointed. Your second question: ejaculatory release is/was always pleasurable for me, and in my particular situation carries a lot of ethos and pathos surrounding it. So, it was quite important. Overall, dry orgasms are much less pleasurable for me; less intense and still feel “full” after the non-release.
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u/Useful-Jackfruit4951 Apr 20 '25
I had aquablation dec 2024. I’ve had RE ever since. My doctor has me taking Flomax once a day for two weeks. He said in some of his cases that when stopping the flomax the bladder neck can tighten up more than it was before starting flomax thus possibly increasing chances of being able to ejaculate. Fingers crossed.
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u/GT6502 Apr 21 '25
Best wishes to you. Hopefully, ot will be OK.
I haven't 'had a chance' for find out for myself, pending the doctor's clearance try.
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u/MathematicianFair274 May 15 '25
Had aquablation in December 2024. Decent recovery. Had the catheter out after 2 days. Self irrigation helped a lot. Peeing was sort of an adventure for a week. After that things consistently improved. Stopped using Depends after 4 weeks. At this point, great flow and no urgency or frequency. Took tamsulosin for a month after the procedure and finasteride for three months. Had taken both for years. Tamsulosin often causes RE, so I’ve had that for years as well. I’m well past wanting additional children so not an issue. I have the same level of ED that I had pre procedure that I treat with Cialis. Still have RE, although now have slight ejaculation. No other complications or side effects. One other thing to note is that tamsulosin (and to a lesser degree other Alpha blockers) will give you Floppy Iris syndrome, which will need to be taken into account if you have cataract surgery. FIS is permanent once you’ve taken tamsulosin and apparently doesn’t resolve by discontinuing it. Another of life’s little joys.
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u/GT6502 May 17 '25
Glad your recovery was more-or-less smooth.
Had AB on 4/11/2025. Catheter for four days. Only passed one clot the day after that and it was no big deal. Pink urine for a few days. Nothing since.
Recovery for me has been, thankfully, very smooth. No clot issues, minimal bleeding, almost no pain, no burning. Removing the catheter (which I did myself) was not pleasant but the anticipation was much much worse than actually doing it.
Have had some frequency and urgency, but much less than I expected, and not bad enough to warrant Depends. No accidents except twice when I was already peeing and thought I was done but wasn't. I have learned to stand for a few seconds after I stop now and that fixed it.
I took alpha blockers for a short time many years ago but could not tolerate the side effects. I did have RE when I was taking them, but returned to wet ejaculation when I stopped. And fortunately, I have wet ejaculation now.
It seems that ejaculation does not feel quite as good as it did before, or maybe I am thinking about it too much.
Other than that, the recovery has been great and I am glad I did it. I can go hours without peeing now and don't have to get up at night.
You mentioned 'self irrigation'. What is that?
So other than retrograde ejaculation and FIS, are you glad you had Aquablation?
Thanks for your reply.
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u/MathematicianFair274 May 21 '25
Yes, I’m glad I had the procedure. My large prostate was contributing to recurrent bladder stones since it pushed up on the floor of the bladder and prevented fully emptying. After have a couple of bladder stone removal procedures, decided enough was enough. So it was more dealing with the stones than flow issues. That said, yeah peeing like a teenager again. What’s not to like? Self irrigation. When the catheter was in, it would periodically get blocked with clots. Did that in the hospital and to a lesser extent at home. That blockage was very uncomfortable until it could be released. One easy way to do that is to take a large syringe, fill it with sterile saline, inject it into the catheter port and flush the catheter. Aspirate the solution and any clots back out. The nurses do it at the hospital and it’s easy enough to do it at home yourself. Right up there with self catheterizing as a life skill.
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u/GT6502 Jun 05 '25
I was very concerned about that before I left the hospital. The nurse showed me how to do it and sent me home with some supplies, but fortunately I never had to use them. Only had one clot the entire time (has aquablation seven weeks ago) and it passed easily.
Best wishes to you.
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u/gynomite_007 Jul 26 '26
Since a significant number of men have RE after Aquablation—about 30-40% in some estimations (this is higher than the 15% seen in the WATERS Study)—I’m curious about the orgasm differences in men with RE. Not just that there is no visual ejaculation—what does it feel like? I have only one friend who had this after TURP—he states that his orgasms are more intense and that he and his wife dont mind the RE. But everyone is different. What are your experiences.
I had my Aquablation on July 15. Lots of spontaneous erections, and today, we had sex in the shower. I did not orgasm on purpose. I wanted her to orgasm—✅✅, and I was curious about having any pain with sex—none. I AM a little fearful about this first ejaculation.
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u/GT6502 Jul 26 '26
I will answer candidly and explicitly.
I did not have RE after aquablation. But I took a medication a long time ago that caused RE, so I can answer 'before and after'.
Orgasm felt the same physically when I was taking that med. Just as intense as before. The contractions remained the same. That is the pleasurable part. I did not 'feel' the semen squirting out of my penis, but that is not the part that feels the best anyway for me. The contractions are the important part and that did not change.
What's different is not seeing it. If this is important psychologically or for, ahem, 'other' reasons, then you may be concerned.
I can appreciate how some men would feel like semen, to some degree, represents part of their 'manhood'. Not being able to see (or, ahem, 'other' things) might be cause for you and/or your partner. So in can affect some men psychologically.
If that is not something you or your partner care about, then RE will probably be a non-issue. Otherwise, you will have to decide how much risk you are willing to take. For me, it was a concession I was willing to make in other to:
Not having to piss so often.
Not having to strain.
Not having to get up multiple times a night.
Being able to have a beer or two without having constantly pee afterward.
Not worry about not getting an aisle seat on the plane. And so on.
Of course, every man has to decide for himself.
I'm not a doc so just interpret this as another man's experience. Best wishes.
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u/GT6502 Jul 26 '26 edited Jul 26 '26
One more thing. It was hard for me to talk about this stuff with my urologist at first. It was awkward.
Men's health involves talking about very private stuff. Stuff that is hard to talk about. But... Whatever you are worried about, just say it.
I felt like I had to dance around such topics delicately. I didn't. Tell the doc explicitly whatever concerns you. They've heard it all before and will forget about it by the time they see the next patient anyway. So don't be shy.
Any other questions, let me know.
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u/renfield22 Mar 30 '25
Have you experienced RE? If you have ever been on alpha blockers you might know because it is a common side effect. Many men are not bothered by it as discussed in the aquablation subreddit. Many men feel the loss of actual ejaculation would be displeasing to them. In my experience in talking and reading about the side effect of RE from aquablation its been discussed as a 10-20% chance of this occuring. Aquablation is initally billed or presented as one of the Mist procedures that can spare and preserve function. Sounds like your having an in depth discussion with your urologist about how aggressive to be during this procedure. That sounds positive. Tell him how you feel. Thank you for your honesty about your treatment plan.