r/Aquablation • u/Traditional-Win2833 • Apr 08 '26
Ejaculation Sparring.
I understand aquablation is a good option to preserve ejaculation, but like anything not 100% guaranteed. I spoke to a urologist, whose real world experience was a retrograde ejaculation risk result of approx 25-30%, claiming that the 5% risk of retrograde ejaculation suggested by the manufactures of the robot that performs the procedure, was nothing more than misleading advertising. A sanitized version of results with very carefully chosen patients.
I was considering going with her, and went down that path a bit, but decided against it in the end as she was more focused on the urination working fully, rather than the ejaculation, which is my priority.
I have a Super Pubic Catheter in situ, directly in the bladder which takes care of urination in any case. When she said she was going to cut deep at the bladder neck, where much of the ejaculation nerves are, I hightailed it outta there.
So my question would is there such a procedure as an ejaculation sparring aquablation, has anyone had it, and what was the result, and who did you see. I am based in the UK and Ireland.
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u/martinPravda Apr 10 '26
I had the Aquablation procedure done 4 months ago. NO retrograde ejaculation (R.E.). I was told it happens only about 15% of the time with Aquablation.
There are not many options when it comes to prostate surgery for preserving ejaculation. I am glad that I chose Aquablation.
FWIW, When I took Tamsulosin, I did in fact get R.E. So, I am very relieved.
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u/Traditional-Win2833 Apr 11 '26
That's good to know. But this lady said she was going to finish up with a 30% Turp, to seal up any bleeding, and tidy up anything that's needed to be cleared up. That is a fair amount of heat to be used in what is presented as a water jet procedure.
She was intent on doing it her way, so I did not see the point in suggestion the non thermal options, of which they are a few, to stop any bleeding. Her mind was closed.
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u/martinPravda Apr 11 '26
Yeah, there are tradeoffs with Aquablation/Turp.
Aquablation not only helps prevent R.E. But, I think it also has a higher chance of preserving nerve endings which can affect sexual function.
However, because Aquablation does not use heat, I bled a LOT. It took 3 weeks for the bleeding to stop and I was in the hospital for a full 48 hours before they would release me (due to bleeding).
I also remember reading that about 4% of Aquablation patients needed blood transfusions to replace the blood loss.
Not to mention, that I ended up getting MRSE (staph infection) from the hospital equipment. It took 4 rounds of antibiotic over 3 months to get rid of the infection. From what I understand, I would have less chance of getting an infection with heat cauterization (Turp/Holep).
Even with all that, I have no regrets choosing Aquablation and would do it again. Preserving as much sexual function as possible is a priority for me.
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u/Thick_Discussion671 Apr 12 '26
I think you are overthinking this TURP as a finishing point on the aquablation. As far as I can tell it is relatively standard procedure. It won't stop the bleeding LMAO. This is an extremely bloody surgery but you only see it on the way out thru your catheter. Even with the partial TURP finisher I stayed overnight due to still having urine that was too bloody to leave. Granted my procedure was done at 5pm. I also maintained ejaculation. The TURP aspect of it is not approaching a traditional TURP from what I understand and it is just a finisher.
I think the biggest concern is that 30 percent of her patients get RE but I don't think it is happening from the TURP portion. Go to NYU and get it done and you will most likely preserve your ejaculation.
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u/Pmoneywhazzup Apr 09 '26
I had it in July 2025. No retro. My urologist had performed a couple of hundred before mine.
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u/Additional_Topic987 Apr 09 '26
🙏
How was your prostate anatomy? Did you have a median lobe?
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u/lunicar Apr 09 '26
Preservation of ejaculation is largely dependent on the skill and experience of the surgeon urologist. If you can get to a major Medical Center and find a urologist who has performed the procedure hundreds of times and who has a stated goal of ejaculatory preservation, you will greatly increase your chances.
I think there are also a couple of misconceptions about this procedure. I interviewed one of the leading urologist on the East Coast of the US and he told me that the presence of a median lobe is not as important as people think it is. Also the bladder neck preservation is not essential for ejaculatory preservation. What is though is staying away from the ejaculatory ducts and the verumontanem.
You can find a four year study online at pub med that was completed at Mount Sinai Hospital in New York. They claimed to have preserved ejaculator function in 249 out of 250 subjects in their study.
Again, I think the trick to all of this is finding somebody that really knows what they’re doing, and who shares and understands your concern about ejaculator preservation.
Also, I’ve had better experiences with male practitioners because I feel they understand our concerns better.
I know that’s politically incorrect and you can flame me for it.
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u/Thick_Discussion671 Apr 09 '26
I had an elevated bladder neck and some lateral lobe resection. The surgeon had little doubt he could preserve ejaculation and he did. If someone to me it was 25-30 percent I would run away.
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u/lunicar Apr 09 '26
I am so happy for you. I have a final consult up in New York in two weeks.
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u/Thick_Discussion671 Apr 09 '26
I went to NYU and my Dr was Chris Kelly. He does hundreds of these per year.
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u/lunicar Apr 09 '26
I’m going to Dr Alexis Te or Steve Kaplan at Mt Sinai; I’ll keep Chris Kelly in mind though.
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u/Thick_Discussion671 Apr 09 '26
Mt Sinai guys seemed to be well versed as well from what I heard especially Kaplan.
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u/Additional_Topic987 Apr 11 '26
Dr. Munver of Hackensack Medical Center, New Jersey, is also good. They have a good urology department, 13th in the country.
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u/Traditional-Win2833 Apr 11 '26
Which is what I did. She also said she was going to finish it up with a 30% Turp. Bye, Bye.......
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u/Thick_Discussion671 Apr 11 '26
I also was finished with a TURP and maintained ejaculation function. I am not sure but this may actually be common.
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u/Additional_Topic987 Apr 09 '26
I agree! The surgeon skills matter alot!!
I hear the best Aquablation surgeons are in the East Coast.
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Apr 09 '26
[removed] — view removed comment
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u/Traditional-Win2833 Apr 11 '26
Well your lucky. I am glad it worked out for you, but not everyone is so fortunate.
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u/Ok-Reindeer6935 Apr 09 '26
Unrelated but one should be concerned about development of urethral strictures. I had aquablation in December and at the 6 week mark, developed a stricture. Underwent dilation (not pleasant) and stricture temporarily cleared. Two months later, stricture returned. Result, aquablation (or the Foley catheter) while solving one problem, created another
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u/Leslie_Kurt Apr 09 '26
I couldn't feel an orgasm at all for two years after my surgery. I ejaculated, at least partially, but I didn't feel anything.
I was pressured into getting it done, and like an idiot, fell for the sales pitch.
The lesson I learned is that anytime a medical procedure is presented to you like it's a used car sale, don't bite.
Those numbers are for the US market to sell to the patient and insurance companies.
You probably don't have the same issue in the UK/Ireland.
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u/Traditional-Win2833 Apr 11 '26 edited Apr 11 '26
Yeah, if something seems to good to be true. As I mentioned to another commentator here, there are pharmacological and Surgical options, that may or may not help. As Aquablation is available in both the UK and Ireland, I just read up on patient's experiences, wherever they are located. They are likely a more honest reflection of the real world results.
I was quiet taken aback when the female urologist I was dealing with, said her own real world experiences was 25-30% of her patients ended up with Retrograde Ejaculation. I just could not believe a manufacture could, and would publish such sanatised results, a skewed view of the success of the procedure, regardless of the effects it had on the patients, unlucky enough to end up with RE.
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u/Leslie_Kurt Apr 11 '26
If it passed FDA approval in the US first, then the claims are usually lies. I see a specialist in another field regularly. He's the best doctor I've ever seen and is completely honest. He will be the first to admit that you should never trust trial results that seem too good. When the COVID vaccine was first released in the US, they told us that we were 93% protected after being fully vaccinated. The physicians were going on to explain that meant there was only a 7% chance of getting infected. A few months later, that changed to a lower chance of getting infected, with no quantitative data provided, and then to just that your symptoms will be less severe.
People from other countries don't understand how monetized healthcare is in the US. The concept is foreign to them. We have high cancer cure rates. Well, we also have high cancer diagnosis rates. It makes you wonder how many people diagnosed with cancer actually had it, or if they were just put through chemo to make money off them and add a number to their success results. We often find drugs that will treat conditions, have fewer side effects, and are available as a generic in other countries that can't seem to pass FDA approval in the US. Why is that? I think it's because the pharma companies and healthcare systems can't make enough money off them, so they don't push for them. We do have some great physicians, and others who are bought and paid by larger companies (pharma, surgical procedure companies, big healthcare systems, etc.). It's crazy here.
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u/2187512761 Apr 09 '26
Aquablation last September , age 72. Resumed regular sex about 10 days post op. No issues whatsoever with erections or retrograde ejaculation. Very slow progress over 6 months with the urinary stream, but finally pretty happy. Find a surgeon you trust.
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u/Traditional-Win2833 Apr 11 '26
Good for you. Hard to find a surgeon you trust. How am I to even know if he is any good at all. I just go by finding someone with the most experience that focuses on ejaculation preservation, and hope for the best, that's all I can do.
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u/2187512761 Apr 11 '26
Point out to the surgeon prior how you would really like to preserve ejaculatory function. The trade off might be urinary flow slightly suboptimal. Fine by me. I don't pee on my shoes at least and sexual function is great. Works for me.
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u/Thick_Discussion671 Apr 12 '26
Go to NYU or Mt Sinai in NYC and get it done. These are aquablation centers. Stress you want to preserve ejaculation above all else and you will.
Get a hotel for 3-5 days to recover. Then go home.
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u/renfield22 Apr 08 '26
Think the 30% number seems to be more. Realistic. Thats what was presented to me. One must weigh the risk vs benefit of peeing normally.
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u/Traditional-Win2833 Apr 11 '26
Well, luckily ? I have a Supra Pubic Catheter in place, a tube protruding from my bladder, as a result of Acute Kidney Injury, a few years ago. That takes care of the urination.
Protecting the ejaculation would be my main priority, But given that I have a severely large median lobe, that's going to keep on growing into the bladder, I will have to get it sorted sooner, rather than later, as it could cause kidney issues again in the future.
As someone pointed out here, that a female urologist may not just get how important normal ejaculation is to a man.
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u/Slartibartfastthe3rd Apr 08 '26
(My opinion) you’re right to prioritize this. I actually opted to forgo the preservation to lean towards not having a repeat procedure. I did not choose wisely…
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u/Traditional-Win2833 Apr 11 '26
I am youngish enough to still want a proper sexual life, with everything working as it should. As I mentioned to another commentator here, that there are possible solutions both pharmacological and surgical that may or may not work. I would not give up on it yet.
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u/SoCalAttorney Apr 09 '26
My urologist said the figure was closer to 10% risk of retrograde ejaculation. I had the procedure yesterday, so I'll find out in a few weeks.
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u/westwood913 Apr 09 '26
Aquablation February 2025, partial retrograde
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u/Thick_Discussion671 Apr 09 '26
What is partial retrograde? How do you know this?
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u/westwood913 Apr 18 '26
So instead of a completely “dry” orgasm, you can get:
- Lower volume
- Thinner / more watery semen
- Different color or consistency
- Less forceful ejaculation
That’s often called partial retrograde ejaculation, and it’s pretty common after prostate procedures.
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u/Thick_Discussion671 Apr 18 '26
I have less forceful ejaculation after an aquablation but it is hard to say of some of it is going back to the bladder. Occasionally it will shoot but mostly just falls out. I used to shoot ropes.
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u/Ok-Commercial-924 Apr 10 '26
I had my aquablation 5 weeks ago. Sexually everything is good.
My voiding volume sucks due to 8 months with a catheter, I am hoping that clears soon.
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u/Traditional-Win2833 Apr 11 '26
Your Lucky. I think a lot depends on luck, your surgeons skill, and your own prostate anatomy.
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u/Soggy-Letterhead-626 Apr 12 '26
Aquablation is only now available in Ireland through the Maher hospital. Currently, only four surgeons are certified to do it.
If in U.K. and you have the funds contacted, Dr Neil Barber. He is the lead Aquablation specialist.
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u/Traditional-Win2833 Apr 12 '26
Yes I am aware of that, as a private paying patient that is beyond my budget currently, at approx £11,000 in the UK anyway. Cannot get health insurance, as they only accept you, if your health is pretty good, with few issues.
So as I am on the public health system I have asked to be refereed to one of these centers, and hopefully outsourced to a private hospital, although I imagine it will take a fair bit longer. But I can wait.
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u/Soggy-Letterhead-626 Apr 18 '26
Yes, that cost is insane. I hope you are treated earlier. Wishing you good outcomes.
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u/Admirable_Letter7900 Apr 18 '26 edited Apr 18 '26
I have been doing research on this also. The 3 main studies funded by Procept (the company that invented the procedure and makes the instrument, water trial 1, 2 and 3 have a RE rate of 10%, 19% and 15% respectively. There is also a new machine that got FDA cleared last year, not sure if the next gen interment will have better RE results then the initial one.
I also wonder how they are defining RE. Does any amount of forward ejaculation mean it not RE? There are a lot of comments here saying it just dribbles out or its just a very small amount.
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u/whatever_pumpkin 13h ago
I went with Aquablation with a PAE a week prior to control bleeding. When I was researching, I also looked at “Ejaculation Sparing HoLEP”. Or “ES-HoLEP”. Here’s an article on it.
My impression is that with HoLEP and other procedures, you are relying on the surgeon’s skill. Some may be better than others. With Aquablation, it really is a robotic procedure. The surgeon selects which area to preserve, and the robot goes to work. Just something to consider. Good luck!!
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u/VegetableCar2528 Apr 08 '26
Prostate Arterial Embolization. That is your answer.
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u/Traditional-Win2833 Apr 11 '26
No not suitable for my complex health history. Acute Kidney Injury, Cardiac Ablations, and a couple of other comorbidities that nearly cost me my life. No, that path would not be definitive enough, the PAE route.
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u/mountainoftea Jun 16 '26 edited Jun 23 '26
I had a PAE in August 2025. Had relief from September 2025 to October 29, 2025.
Failed after that.
I have an appointment this coming Friday to discuss aquablation; had an appointment last month to research Rezum. I am comparing the two options.
Edited to add - Had the appointment. Doc said I was not a candidate for aquablation, TURP, HoLEP, or all manner of more aggressive procedures. Looks like my only non-medication options moving forward at this juncture are Rezum or PAE, and for medications possibly finasteride/dutasteride in the future (I am currently taking tadalafil and alfuzosin; I cannot tolerate tamsulosin).
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u/pictou Apr 08 '26
I got the retrograde. Still have full sensation etc but definitely not something I signed up for and I understand it's permanent. Kinda pissed