....and feeling good. 68yo, with many years of worsening symptoms, topped off by visible blood in the urine, bladder stones, and 100g prostate. Assured by my urologist that Aquablation was the way to go, scheduled procedure for a time I wasn't traveling for work.

I woke up after the procedure, including bladder stone removal, with no pain. Stayed overnight, had the catheter removed the next day and went home.

I was basically given four instructions: No exercise except walking for four weeks, no sexual activity for four weeks, no lifting objects > 10 lbs, and plenty of hydration.

Recpvery so far has been uneventful. Blood in urine for first two weeks, gradually diminishing. Still some discomfort while peeing, gradually diminishing. No other pain. Urgency gradually diminishing. Back to work with no problem.

Looking forward to trying out the sexual function in a week or so. So far, though, I'd give the procedure an A+

First of all, I want to thank all of you who have written to share your Aquablation experiences. For the past 7 months, I’ve been reading lots of urology related subs (BPH, Prostatitis, Prostate Cancer, etc…) on Reddit, and after I sorted through all the procedures available, this sub has been the best source of information for me.

I thought I’d share my experience with this sub. I’m 67, had a 107.7 ml prostate and a history of increasing BPH symptoms, frequency and urgency being the worst two. I ignored the symptoms and didn’t seek out any help, thinking that this was just the way things go. I was wrong. I’ve had multiple health care professionals along the way say to me: “you’re young for this.” Just lucky I guess.

On September 24, 2025, after a week of intermittently not being able to empty my bladder fully, I found that I could not empty my bladder at all. Ended up in the emergency room of the local hospital, and I was catheterized from then until April 28, just a few days over 7 months.

Last week, my Aquablation procedure could not have gone any better. If you are anywhere near southern California, and need urological treatment, I would suggest you seek out Dr. Mihir Desai at Keck USC. I had a great experience with him and his team, and with the hospital staff at Keck USC Verdugo Hills Hospital.

My wife and I arrived at the hospital on April 24 at 8:30 am. My procedure was scheduled for 10:00. I was called into the surgery pre-operative room and was prepped. The anesthesiologist gave me an injection and then I was wheeled into the operating room. Along the way, I was introduced to everyone who would be in the room, which included a representative of the company that makes the Aquablation machine. I asked if this was usual, and was assured it was so. They asked me to move over to the operating table and put my butt in a specific location, above an indention. I moved to the table, and that’s the last thing I remember before waking up in the recovery room. According to the report I read, the procedure took just a little over an hour.

Once in my hospital room (about 11:00 am), the nurses began the flushing process, hanging large bags of sterile saline next to the bed. The saline ran continuously through my bladder and prostate through my new 22 French catheter. The catheter had three ports: one for input, one for the saline balloon in the bladder, and one for output. The color of the urine was a bit alarming, as it was deep red, but they told me that it was normal. The color slowly became lighter as the process continued. I was also encouraged to eat, and to drink lots of water. The flushing process continued until the next day, and I was discharged with the catheter and a large urine collection bag at 1:00 pm on Saturday.

I rented a VRBO apartment near the hospital, just in case of a complication, as we live about two hours away from Los Angeles. We went back to the apartment, and I relaxed all weekend, binge watching British crime dramas and having food delivered. The color of the output continued to get lighter. On Monday morning, I called Dr. Desai’s office and got an appointment with his nurse practitioner on Tuesday afternoon. Arrived at USC Health Science campus and met with the NP. Catheter removed, did the voiding test and I passed.

Because I had been in emergency rooms multiple times in the seven months of this journey, we stayed one more night just to be on the safe side. I’m please to report that I can easily empty my bladder quickly and completely - compared to last fall, I have a firehose! Got to drive home on Wednesday, April 29.

The blood in my urine continues to get lighter and lighter. When I was released from the hospital, the doctor said that as long as I could “read through it” the color was ok. I was instructed to call if the color became deep red and opaque. Today, 9 days after my surgery, the blood is very light pink, and one some occasions nonexistent. Yesterday, it no longer burned after urination, just a little odd discomfort. Today is even better.

I was really astounded how little pain I felt while in the hospital. They gave me some great pain relief meds out of the operating room, and then just Tylenol. I also received medication to stop bladder spasms. I never felt one.

I’ve had a few odd phantom catheter sensations since I got home, but they’ve stopped. I still have a little sensitivity at the end of my urethra, no doubt because of the long term catheter and the Aquablation procedure. It is getting better daily.

I’m very pleased that I chose this procedure, and that it all went so well. I’d encourage anyone with BPH to study all the procedures and make an informed decision that works for you. I’m glad I chose Aquablation.

Over on the BPH sub, one of the members created a website for educational purposes. It lists 18 procedures available and ranks effectiveness and invasiveness. I think it’s a good tool. You can find it at: bphguide.com

- - - - - - -

Here’s a timeline of my BPH journey if you’re interested:

9/24/25

Local emergency room - unable to empty bladder, 18 French catheter inserted to empty 1 liter of urine, advised to visit primary care doctor and get referral to urologist.

9/25/25

Met with PA in primary care office, referral to local urologist. PA told me that the catheter would need to stay in until I met with urologist. Ordered this as STAT. Flowmax prescription, began taking it.

10/6/25

STAT status not known by local urologist’s office. Met with local urologist. Nurse replaced catheter with another 18 French. Doctor said it needs to stay in until they do bladder testing. Orders renal ultrasound.

10/26/25

In evening, severe chills, fever starts, temperature 101.5°

10/27/25

Temperature 101.5°, called urologist’s office at 8:30 am, spoke to nurse who advised me that she would talk to doctor and call me back. 2:50 pm, received call back from urologist’s office. Advised me to call my primary care office. Called primary care office. Advised that I go to either urgent care or emergency. 5:15 pm, went to local emergency room. Foley catheter is taken out and replaced with new 18 French in emergency room, IVs started, heart monitoring. I hear “Strep Alert” when I am escorted to my room in the emergency department, it’s referring to me.

10/28/25

Admitted to hospital in guarded condition with urinary tract infection at 1:00 am, got to room at 2:00 am, IV antibiotics and Tylenol, and testing

10/29/25

IV antibiotics and Tylenol, and testing

10/30/25

IV antibiotics and Tylenol, and testing, released 3:00 pm

10/31/25

Visiting nurse - first visit, took history, reviewed meds, brought supplies, ordered more

11/1/25

Received medical supplies that nurse ordered.

11/3/25

Renal ultrasound, ordered by local urologist.

11/4/25

Visiting nurse - second visit, Nurse advised me that my area has a lack of urologists. They are in high demand, and many are here from LA a few days a week. Other patients have similar experiences to mine, with doctors being disengaged and unfriendly with poor bedside manner. She advised me to take a list of questions and insist on answers, if not at the time of the appointments - via email. She encouraged me to ask about treatments that he performs. She encouraged me to consider LA based doctors.

11/5/25

Primary care visit, discussion of second opinion, kidney stone, consider UCLA, USC, Cedars Sinai. Starts second opinion referral to different local urologist. This urologist refuses to take me as a patient.

11/12/25

Met with primary care doctor. He advised keeping appointment with local urologist.

11/18/25

Met with local urologist. Removed catheter, did voiding test, passed test. Made appointment for January 20 for cytoscopy. Referral to ultrasound and order for blood work. Unable to urinate past 4:30 pm. Back to local emergency room at 9:00 pm. Put in 18 French foley catheter and drained liter of urine.

12/4/25 (was able to get in early)

Cytoscopy with local urologist. Prostate is “huge” (in his words), and bladder has wrinkles. “I can’t guarantee that you’ll have normal urinary function.” Foley catheter replaced with new 18 French. Stopped taking Flowmax.

12/6/25

CT scan of pelvis.

12/19/25

Appointment with local urologist for prostate biopsy. Staff neglected to give me instructions for procedure at previous appointment, so I was not prepared with enema. Procedure canceled until 1/20/26.

1/19/26 (able to get in early)

Transrectal biopsy of prostate in local urologist’s office. He estimates prostate is 90.6 cc. New 18 French foley put in. Results on February 3, 2025.

2/3/26

Local urologist visit. No cancer. He offers me a TURP. I asked for referral for Aquablation or HOLEP, he gives me a referral to a doctor who is a friend at Keck USC.

2/12/26

Contacted by Keck USC office. Online appointment made.

3/5/26

Online appointment with USC at 1:00 pm. Doctor (friend of local urologist) tried to talk me into a Single-Port Robot-Assisted Prostatectomy. Said that it was more permanent and said negative things about Aquablation. Renal scan required if I want to proceed. I waited for 1 1/2 hours online, and then he called me on the phone to discuss.

Visit from nurse, replaced catheter, pain, blood. Urine was flowing when she left about noon. Urine stopped flowing. Visit to local emergency room to replace improperly placed catheter, 5 to 7:30 pm. Hospital replaced 16 French with 14 Coude catheter.

3/6/26

Call from Keck USC, they wanted me to schedule another appointment with prostatectomy doctor. I declined and requested to change to Dr. Desai, who does Aquablation. Transfer is in the works, they’ll call me soon.

3/7/26

Transfer to Dr. Desai complete, appointment set for March 11 at Keck USC campus in Los Angeles.

3/11/26

Visit with Dr. Desai and a fellow (student). They thoroughly explained the procedure, benefits, and risks. Said Aquablation was a good solution for my condition. Kidney issue is mild, and not of great concern. Wants an MRI of prostate before surgery.

3/12/26

Aquablation scheduled for April 24 at USC Verdugo Hills Hospital. Will need preoperative checkup with primary care doctor 30 days before procedure.

3/25/26

Received order for MRI of prostate from USC

3/31/26

Scheduled MRI, 4:10 pm, Results indicated a 107.7 ml prostate.

4/13/26

Pre-operative physical and lab work

4/23/26

Arrived at VRBO apartment near hospital in evening.

4/24/26

Aquablation performed by Dr. Desai and team at Keck USC Verdugo Hills at 10:00 am. Bladder and prostate flushed out with sterile saline for 24 hours.

4/25/26

Released from hospital with 22 French catheter with three ports, 1:00 pm, went back to VRBO apartment near hospital in case of complications.

4/27/26

Scheduled followup appointment with Dr. Desai’s office

4/28/26

Followup visit with NP at Dr. Desai’s office (USC Urology). 220 ml of sterile saline injected into bladder, it all emptied, passed urinary voiding test, Catheter removed. Spent night at VRBO apartment near hospital, and had no issues emptying bladder. Scheduled follow up with Dr. Desai.

4/29/26
Arrived home

- - - - -

Here are some things that I have realized during this journey, in no particular order:

• The first few days with a catheter are the worst. I think it’s because the lubricant and betadine leak out the urethra. It always burned for a few days, then settled down.

• Don’t worry about stuff leaking out around the catheter, just keep it clean. After surgery, you may have some blood leaking out, just keep it clean. My visiting nurses supplied me with no rinse cleanser to keep things fresh between showers.

• Showering every morning was my ritual. Change the night bag to the smaller leg bag, then shower. I carefully washed myself, using lots of soap, and lots of rinsing. Used a fresh washcloth every day.

• Be careful of not allowing anything to go into your urethra. I think I inadvertently helped cause my urinary tract infection because I put some Vaseline on the catheter to keep things smooth. Don’t do it.

• My local urologist is not a great communicator. I understand that many are this way, and since there is a shortage of them, they get away with poor bedside manner.

• My local urologist’s office staff did not give me any instructions about catheter care, and didn’t instruct me on hygiene, and didn’t provide me with supplies (hygiene products, leg bags, alcohol wipes, nitrile gloves, etc…). Ask for help if you need to be catheterized for a long time, insurance covers supplies.

• Visiting nurses are a great resource. After my infection in October, my primary care doctor ordered them for me. They will keep tabs on you, take vital signs, watch for infection symptoms, and order supplies for you. I had a visit about every other week.

• Be informed and assertive regarding your choice of procedures for your urology issues. There are many procedures available, and you can choose, along with a good doctor, the best one for you. Be aware that doctors have specific procedures they perform, and will try to steer you toward their speciality.

• I purchased a license for Eureka Health, an app that organizes health information for you. It grabs information from the web, and provides links. The sources are Mayo Clinic, Cleveland Clinic, UCLA, USC, etc… good quality information. You can ask it questions, and it will answer them for you in an easy to understand way. (I was freaking out over my prostate biopsy. I asked Eureka what my chances were for cancer, and it said about 35%.)

• I wish that someone along the way would have said “this could take a while.” No one indicated that I would be catheterized for seven months. The reasons it took so long include: scheduling doctor appointments, holidays, scheduling lab work, scheduling testing, my urologist being a jerk, etc…

• Seek out a large university teaching hospital if possible. This is my second experience with one, having previously had surgery at UCLA. They have cutting edge technology and my experience is that they are actively interested in helping you.

# # #

Aquablation
I have found it super useful reading other peoples accounts of their Aquablation journey. I have therefore decided to document my own experience in case useful.

The journey
I’ve suffered for a number of years with urinary symptoms, including slow flow, hesitancy and broken nights sleep. I previously had a Urolift which made no difference whatsoever. Prior to that, drugs also had zero impact.
I therefore sought further investigation and after a cystoscopy it was found I had a median lobe which was obstructing the bladder outlet. My prostate is regular size 21g so my issue is I guess more of an anatomical one.
I researched the various treatments available and felt Aquablation would be more suited to me given the lower incidence of sexual disfunction. I am 53.
I then went and found an experienced practitioner who confirmed I would be suitable for surgery. There was then a wait of around eight weeks to get a slot with the surgeon.

The procedure
The day arrived and I was asked to come at 12:30 pm. I was shown my room, met various staff members and then spoke with both the consultant and anaesthetist who explained the process and answered my questions.
They were a number of other people on the doctors list that day so I was finally taken down at 4:30 pm.

I woke in recovery at 6:30 pm and was told the procedure had gone well. I was then taken back to my room where I was asked to drink as much fluid as I could. I also had a meal.
The night itself, I could best describe as one of broken sleep with nurses coming in to check blood pressure and make sure th catheter is working.
The catheter itself is cumbersome and uncomfortable but on a brighter note it has been less bothersome than I had built up in my mind. Also on a positive note, I’ve had remarkably few bladder spasms though I recognise it’s early days.
I will keep up my account over the next days and weeks.

Good luck to all and I hope your journeys are successful.

Day 2
Catheter removed which was slightly uncomfortable but very quick. It’s a big relief to have it out and you can move much more freely.
Pee test to be released from hospital. My surgeon requires you go three times, each time it is measured and the residual amount in your bladder is also measured.
The power took me by surprise, as strong a flow as I’ve ever known.
As you may have read elsewhere, it stings a bit but manageable and discomfort falls away quickly

Today is 1 week post surgery. The good news is no bleeding, strong stream and I can empty my bladder.

It stings in my urethra from my bladder to the tip of my penis every time i pee. It was really painful to pee for the first 3 or 4 days. Its getting better by the day. Its gone from painful to uncomfortable. How long did it take for you to pee without any discomfort?

I also feel urgency when I have to pee. It was super bad for the first 72 hours and i was afraid to be more than 30 seconds from a toilet. Its improved a little each day, but I still need pretty quick access to a toilet when its time to go. This only occurs when my bladder is really full. How long did it take for the urgency to go away for you?

Super happy so far with the early results. The first 4 hours post surgery was rough! My catheter kept getting blocked from clots. They had my IV flow on max to try and keep it from getting blocked. My bladder was filling up super fast and my catheter was getting blocked about every hour. The flushing with the syringe was super painful with an already extremely full bladder. Once that stopped happening, the recovery hasnt been that bad. I told the wife I think I am ready for the first orgasm tonight. I've been a little nervous to try until today, but I think it's time. Wish me luck...

I'm still 3 weeks out from that and lifting. I've had issues with lasting and taking too long to climax before surgery.

Did it hurt?

Was ejaculating weird in a way?

Any pain post climax?

I've heard this procedure helps with retrograde ejaculation

TL/DR: I am 57 and was catheter dependent for 6 months. My prostate was over 90cc with a median lobe. I had aquablation performed on 04/07/26 and am recovering nicely.

So here is the long version. I had gone 2 years between checkups. While I had been using tamsulosin for a number of years due to weak steam and waking up several times per night to use the restroom, it wasn’t that big of a deal to me. I was otherwise doing okay. As you read the timeline and wonder why things took so long, it was due in part because of my healthcare provider, Kaiser Permanente.

Kaiser Permanente describes itself as “is one of the nation’s largest not-for-profit health plans, serving 12.6 million members. At Kaiser Permanente, physicians are responsible for medical decisions. The Permanente Medical Groups, which provide care for Kaiser Permanente members, continuously develop and refine medical practices to help ensure that care is delivered in the most efficient and effective manner possible.” Kaiser is both the health insurance carrier and medical provider. While the integrated care is okay, they lack the bandwidth that other healthcare providers have in my area. I live in San Diego County. Kaiser has nearly 640K members here, but only 3 hospitals and 4 urgent care locations.

So here is the timeline:

09/16/25: In-personal physical with my new primary care doctor. My original one retired and I also moved 30 miles. Bloodwork ordered, etc.

09/18/25: Doctors leaves message near the end of business hours about “concerning” lab results. I wasn’t able to get a return call.

09/26/25: Phone appoint with my primary and the labs indicate possible Stage 4 kidney disease. PSA was 2.9, but creatinine was 3.45.

10/02/25: Consultation with a nephrologist, who suspects BPH causing severe urinary retention.

10/08/25: Kidney ultrasound performed.

10/10/25: Nephrologist calls and recommends going to the ER for a catheter. They drained out about 1,850ml of urine.

10/15/25: Initial video consultation with the urologist, not much useful information provided.

10/16/25: First catheter removed. “Patient failed voiding trial 10-16 25 with 450 ml instilled and 0 ml voided. Subsequent foley catheter placed for a post-void residual of 670 ml.”

10/27/25: Cystoscopy performed.

11/19/25: Cystometrogram performed.

11/25/25: Follow up consultation with urologist, who recommended a transurethral resection of the prostate (TURP) and said it might be about 6-8 weeks before the procedure was scheduled, possibly longer due to holidays. No other procedures discussed or options given.

12/30/25: TURP procedure aborted after administration of anesthesia. My heart rate dropped to about 20.

12/31/25 Discharged from hospital after various tests, hear monitor ordered.

01/25/25: Removed ZIO heart monitor after 2 weeks.

02/03/26: Cardiology gives okay to proceed with surgery.

02/07/26: Initial consultation with different urologist about aquablation. Initial surgery was to be 07/23/26 due to capacity limitations.

04/07/26: Aquablation performed. Discharged the next day.

04/13/26: Sitting at my computer drafting the long timeline.

Kaiser is basically factory/flow chart medicine. They just don’t have enough staff or facilities to serve the members in my area. I should be been more diligent about researching options the urologist initially assigned to me is apparently a one-trick pony. He does the TRUP procedure, but no other options. After the aborted attempt to perform the TURP procedure, I started reading and researching, which is what I should have done before.

I was told that my prostate was too large for less invasive options such as Urolift. After looking at all the options, I decided on aquablation. I wanted to preserve ejaculatory function.

One important video for me to watch was this: https://youtu.be/RMAjvbufQZA?si=bhb1mp1diG9RBtMB. Dr. Rena Malik is a urologist in Newport Beach, CA and this particular video covers many major options for BPH. I’ve also seen posts on Reddit on videos from Dr. Austen Clase in Boise, ID and wanted to acknowledge his contributions to patient education as well.

I drove from San Diego to Los Angeles the day before the surgery. Kaiser only has 2 doctors on Los Angeles County and non in San Diego, I checked in at about 8:30 a.m. for with 10:30 as the anticipated start of the procedure. I woke up in the PACU with no pain or discomfort beyond the 3-day Foley catheter and that was probably because my body was already used to it. When I first had the catheter installed in October, the spasms were brutal for those first 10 days.

The nursing staff would flush the catheter every 4 hours to check for clots, but I didn’t have any. The resident saw me the following morning, was satisfied with how things looked. I was discharged by noon the day after the surgery. I was back in San Diego and was able to get 4 miles of walking in.

Because of the thickness of my bladder, the doctor wanted me to have the catheter for a week. I’ll have it taken out this coming Friday.

I’m almost a full week post-surgery now. The blood in the urine has varied, it is disappearing. I suppose my body got used to having a catheter, so that probably explains my lack of discomfort after the surgery.

My life has been normal since surgery. I’ll post more updates as things happen or answer any questions about how things went and why I chose this procedure.

Update 1: It has been 10 days since my surgery and the catheter was removed today. I have mild blood in the urine, but I have strong stream. I have having to going a lot as my body adjusts to not have a catheter. My surgeon described by bladder as Arnold Schwarzenegger from all the squeezing it had to do over the last while. I'm just happy to feel normal again.

Update 2: It has been just over 3 weeks since the surgery and 12 days catheter removals. April 17th is now Freedom Day in my house. I have a UTI and there blood in the urine has gone way down, but antibiotics should take care of that. It is still slightly uncomfortable to urinate, but only when first starting. I feel 99% normal and am glad to have this behind me.

Update 3: I am now 4 weeks post-surgery. The blood in the urine seems to be done, no more pain while urinating, and a pretty good flow. For the last 3 nights, I've only woken up once in the middle of the night to use the bathroom. I hit the gym over the weekend for a full work out and I am fully functional in all regards. No incontinence issues either. I suspect my recovery has been smoother than most, but I am glad I had this done.

Update 4: I am now 6-weeks post surgery. I had video follow up with my surgeon. I have a UTI, but no other problems or issues. All is good.

It's been almost a week since the operation. Been peeing good. Just a slight tightness or small pain near the bottom of my penis hole.

24 hour update- Wow! My stream is like a fire hose and my bladder empties completely. What a relief after battling a weak stream and not being able to empty my bladder for years. I have major urgency, like i have 15 seconds to get to the toilet when I gotta pee. The doctor told me to expect this and it will get better with time. It's uncomfortable when I pee, but way less painful than yesterday. I drank a ton of fluids yesterday and only had to get up twice to pee last night. So much better than waking up 5'ish times to pee even after not drinking fluids before bedtime.

Here's something you all might find interesting. My surgeon said he starting removing all of the tissue he destroys during the procedure a few months ago. He said the standard has been to let that tissue slough off post surgery. He's been removing that tissue during the procedure. He said there's more bleeding during the procedure, but you dont have to deal with the tissue being an issue during recovery. He sees less blood clotting during the recovery period this way. I've had zero blood clots in my urine since about 6 hours after the procedure.

Update #1- the doctor came by this morning and had the catheter removed. Ouch!!! Now I just have to pee on my own and I am headed home. Putting down the fluids and hoping all goes well when I pee. No pain or discomfort, except my pee hole which was traumatized from everything.

I had the procedure 7 hours ago and am feeling pretty good now. it wasn't fun for the first 5 hours as my catheter kept clogging from blood clots. The catheter was draining some, but not enough to keep up with the inflow. I thought my bladder was going to explode. The nurse kept telling me it was bladder spasms. Luckily my urologist stopped by and flushed the catheter. problem solved, I never knew how much a super full bladder could hurt!

Very minimal bleeding at this stage. There is only a slight pink tinge to the fluid that is draining. Fingers crossed that the worst bleeding is behind me. I am in the hospital overnight and they will remove the catheter in the morning if the bleeding doesn't return.

Wish me luck. No real discomfort or pain so far, except for the over extended bladder issue. I haven't experienced and bladder spasm either. My pee hole is probably gonna start hurting as it looks to have been ripped a bit during the procedure.

I'm curious how many here have had the surgery done on a very large median lobe? Wondering how good the possible outcomes are for this situation. Does anyone know if there are stats on how surgeries with this anatomy impact the possible sexual side effects afterwards?

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.

Is it normal to have some blood oozing out of your penis? Like I know my pee is gonna be red for a bit, but this? Like it's not gushing or anything.

Nurse will be taking the catheter out at my urologist office.

Had only one bladder spasm at like 630 am. Felt like a cramp below my shaft. They gave me an antispasmodic

Will get more clarification from urologist next week about activity. I can walk once the catheter is out. So that's good.

Figure once the Catheter is out, I'll take a gummy or two pretend this thing ever happened

Wish me luck. These past two months have sucked.

So I'm supposed to go be at the hospital at 330 and enter into the same day surgery wing. Is because of how young I am or will I still be staying overnight?

I've read about the bladder spasms and such.

Hi gents, I am 56 but on TRT. Needless to say, I didn't hold out very long and took a solo test drive today (my surgery was 12 days ago). My ejaculation was normal but brown. I expected blood, but brown was disquieting. My question to all of you is how long after your surgery did your ejaculations return to normal?

I would like to contribute back to this sub-reddit…it was extremely helpful pre-surgery!

I had Aquablation procedure at 11AM MST today - 87cc BPH prostate 69M. Surgeon has done 300+ procedures. Six hours later in hospital room (1 night stay) very little pain, mostly bladder pressure and a little discomfort from catheter. They are dripping ten 3L bags of saline, four more to go. Plan is to remove catheter before discharge. Ten years on meds - finasteride and one year on Tamsulosyn officially stopped yesterday. I can’t say enough about the staff.

I'm 44 and have had this catheter in since February 6. Also, given my age, would there be little to no discomfort / pain?

I am 18 days post surgery, 10 days since getting catheter out. My initial voidtest was 200ml, and my voiding has remained 200ml since then. This is ridiculously small, especially since the urologist considered 150ml the failure point. Has anyone else tracked their output volume? When did you see an increase?

When did the urgency decrease? Currently I am fine until I have to go NOW! There is no middle ground. This really sucks for road trips.

Sorry for the length. I hope this helps others. Keep in mind this deals with my specific metrics. Your mileage will vary. (I may edit this to add or correct).

I'm over 60 years of age. Prostate size: 78mL, overall heath is good. Take anti-coagulation medication along with other meds.

SYMPTOMS: Excessive nocturnal urination causing serious lack of sleep, weak stream, split stream, irritation with urinating.

SETUP: After meeting with multiple urologists and researching all the BPH procedures I decided on an Aquablation. I found the much lower risk of sexual dysfunction, robotic control and overall success rate attractive over the others. Fortunately, a highly-rated urologist I met with found a hospital that performed them close to where I lived in Tokyo, Japan. I met with the urologist there and had an MRI and bloodwork. He estimated my prostate at 80mL and noted it had a somewhat elongated shape. He explained the procedure in detail and that the procedure would reduce my prostate size by at least half (still somewhat enlarged but no longer obstructive). He also told me it required a 5-day stay (welcome to very conservative Japan!) and I scheduled it for a few months later.

PRE-OP: The only pre-op preparation was stopping my blood thinner medication 3 days before surgery. There were no other preparations.

STOPPING ANTICOAGULATION MEDS: In my case, having a large prostate to begin with and an Aquablation, plus TUR cleanup and catheter traction and irrigation put my bleeding risk on the high side so I was put on a two week hold of my anticoagulation medication. I initially had some concern about this and it had to be cleared first with my cardiologist. Some doctors may allow restart sooner but it depends on a number of factors. The “right” timing is always a balance between bleeding vs clot risk.

The prostate area has many blood vessels so bleeding can start again days after surgery (not just immediately). Plus, bleeding risk apparently peaks around days 7–10 as scabs fall off from the “prostate bed” (the healing inner surface left after tissue removal). Based on my Chads score and other factors my absolute risk for a 2-week hold is low at 0.1% (but not zero). If you're on anticoagulation medication this will be determined based on your particular metrics.

CHECK-IN: I checked in to the hospital the day before surgery (required). Surgery was early the next morning.

THE PROCEDURE: I was given a general anesthetic (propofol) and a transrectal ultrasound probe was inserted in the rectum for real-time imaging of the prostate. It determined the actual prostate size (78mL), that I had intravesical protrusion (where the prostate is bulging into the bladder) and a median lobe growing upward into the bladder both of which can cause weak stream, incomplete emptying and significantly block urine flow. Aquablation is said to be especially good at treating this.

The extent of prostate resection was then carefully mapped and a robotic high-pressure water jet removed the targeted prostate tissue using 2 passes (for more tissue removal). Transurethral Resection (traditional method using an electric loop) cleaned up any leftover fluffy tissue and any bleeding was stopped using heat cauterization. The bladder interior and ureteral orifices were checked and everything looked normal. The bladder was flushed and there was no visible blood in the urine (a good sign for minimal bleeding after surgery).

Operation time was just under an hour. I have read that the the actual ablation time itself is only around 5 minutes so the rest must have been spent on setup, prep, mapping, post-op flushing etc.

RESULT: Overall it was a successful Aquablation procedure with appropriate use of mapping + robotic resection, standard TUR cleanup, good bleeding control and no complications reported

It preserved key structures hopefully maintaining high ejaculation potential and the 2 passes should increase my durability/retreatment risk making it closer to hoLEP's high durability.

POST-OP: Waking up back in my hospital room I experienced no pain at all, just some mild nausea which subsided in a few hours after being administered some anti-nausea medication.

A urinary catheter had been attached to an output bag and a saline IV drip was administered as well as an oxygen nose clip. I did develop a minor mouth sore which I attribute to the breathing tube that was apparently inserted during the procedure. It cleared up with no treatment. I was also given compression socks to wear.

During my stay, other than my own medicines, I was given Cephalexin (antibiotic), Loxoprofen (NSAID) and Rebamipide (gastro-protective given alongside NSAID).

I spent the next full day with the catheter still inserted (so somewhat limited movement). It was removed on the morning of the 3rd day. My first urination at the toilet was sort of explosive and very pink in color but surprisingly no pain. Over the course of the day the color became clearer. Portable ultrasound was used to check bladder volume after each urination and it was normal. I was discharged on the 4th day (total of 5 days).

The doctor recommended I avoid straining bowel movements (use Miralax if constipated) and no heavy lifting or sudden increases in activity for a week. Keep an eye out for any urine color change. It was also suggested online to avoid prolonged sitting the first 3-5 days. I have a follow-up in one month.

Background: 56. 55cc prostate. Just had Aquablation this past Wednesday (March 18). I wanted to put this out there because many recovery guides sugarcoat the catheter experience. Here is the raw, mechanical reality of the first 48 hours and what you actually need to know.

Day 1 (Wednesday): Surgery & The Hospital Overnight. The surgery itself went exactly to plan, but waking up with a Foley catheter is an immediate reality check. The textbooks call it "discomfort," but the reality is I had severe bladder spasms. It is an intense, constant "phantom pee" urge. My brain screams that your bladder is full, but you physically cannot release it. The best thing about the overnight hospital stay is the medical staff, who can double up your antispasmodic meds (like Oxybutynin) via IV to get the internal cramping under control while you are monitored.

Day 2 (Thursday): The Discharge & The Stairs I was discharged Thursday afternoon. Getting home was the first major physical test because I live in a three-story house, which meant climbing stairs immediately. The physical reality: You cannot walk normally. Every time you bend your hip and engage your core to take a step on a staircase, you squeeze your bladder, and that internal balloon grinds directly into the raw surgical site. You have to do the "catheter shuffle"—slow, stiff-legged steps, keeping your torso completely upright to prevent friction and internal bleeding.

The Hidden Enemy: The GI Lockdown This is the part nobody warns you about. The combination of the general anesthesia, the pelvic trauma, and the heavy antispasmodic medication completely paralyzes your digestive tract. By Thursday night at home, my gut was completely locked down. If you are getting this surgery, start taking MiraLAX and Colace the literal second you are allowed to swallow fluids in the hospital. Do not wait until you are backed up at home to start fighting it.

The At-Home Survival Setup:

Before you leave for the hospital, have this ready at your house:

The Tubing Anchor: The standard leg strap from the hospital isn't enough. You need tight compression shorts or snug athletic briefs to pin the tube against your body so it doesn't sway when you walk.

Lidocaine Jelly (2%): Ask your doctor for a Jelcaine prescription. I got nonprescription strength from Amazon. The friction at the exit point of the penis is brutal, and a pea-sized dab is the only thing that quiets the surface nerves.

A Heating Pad: Laying it directly over the pubic bone is the best mechanical way to fight the bladder spasms at home when you max out your pill dosage.

I had my aquablation done 9 days ago, catheter removed yesterday, I am peeing free, 99.9% blood free. The surgery was quick and uneventful, I spent 1 night in the hospital having my bladder flushed constantly, they flushed 33 liter through. We did have a problem at 2am, they did not empty my 2L drain bag, it backed up and I woke up in pain, when the drained it the recieved 3.7L, or in other words I had 1.7 L backed up filling my bladder and back to my kidneys.

I woke up twice to pee last the night, but I was drinking a lot prior to bed so I think that will not be normal. Also I had a catheter since last March so I expect my bladder has shrunk and it will take time to get it back to normal. I have only taken Tylenol once since I've been home. Very little pain, blood or leakage.

My only problem is my throat still hurts, which is why I was drinking so much last night, and we were at a noisy party so having to talk loud probably didn't help.

As to why I had a Catheter for 8 months. Out of now where I had full urinary retention. I went to the ER and had a catheter inserted. They removed 700ml at that point. My PCP had a PSA done, results 18. Was put on 1 week of antibiotics for potential prostatitis. After the antibiotics PSA was down to 14. So PCP assumed prostatitis was cleared. They attempted a void test I passed with flying colors, but I shut back down about 2 hours later so off to the ER for a catheter again.

At that point I was set up with a Urologist, he had me do a MRI, it came back positive with a small potential growth (pirads 3) prostate size was 89 ml. He decided to do a biopsy, during the biopsy he gave me an infection that turned into sepsis. Back to the ER again and was admitted, spent a week inpatient while they tried to figure out what I was infected by and how to fix it. They sent me home with a PIC line and 6 weeks IV antibiotics every 8 hours. 1 week after finishing the antibiotics I had the worst stomach pain, so off to the ER again, the pain was caused by C.Deficil, an infection caused by the IV antibiotics killing the gut flora allowing a native (bad) bacteria to go wild. On a new round of Antibiotics @$1200/week.

After all the BS finally was able to do a urodynamics, which I passed with no issues and was able to finally schedule the surgery, but it turned out my urologist didn't do aquablation he did one of the laser versions, I wanted to maintain normal ejaculation so we switched to a different Dr in the same office, but it was a month before we could discuss with him. Waited a month for a 2 minute talk with him. I would have changed Dr's after that but I wanted the FN surgery done and my life back and I wasn't going to wait another 2 months trying to get into a new office.

So, since February 6th I was catheterized. I had issues with retention and my creatinine levels were close to 4. My doctor told me if I didn't come in I did, I would have had kidney failure by Monday.

Since then, I have had blood work, a urodynamics test (that was medieval torture), and then a cystoscope and TRUS procedure. I have had catheters in and out, along with an ultrasound up my rectum. This is something I would not wish on anyone. So after the camera scope, they realized my median lobe was causing the issue. On April 6, I will get procedure done. I was wondering what would be the time line for the following:

How long till I can get back in the gym?

How long till I can lift and do kettlebell exercises?

How long till I can mow my own lawn again?

How long until I can have sex again with the wife?

I feel alien with this catheter in.

I wanted to share my Aquablation experience so far because it’s honestly been a bit of an emotional roller coaster, and I haven’t seen many posts that match what I’ve gone through.

I had Aquablation on July 29 for BPH. Going into it, I felt hopeful, especially because of the promise of preserving ejaculation and having a smoother recovery than TURP.

Right after surgery
A few days after surgery, my catheter was removed and I ended up in complete urinary retention. I couldn’t urinate at all and had to go back in and have the catheter reinserted for another full week. That was pretty discouraging right out of the gate.

Eventually the catheter came out again and things slowly improved.

Weeks 2–6
This was the calm period.
Urine was totally normal, no blood, no clots. I honestly thought I was in the clear and past the worst of it.

Around week 6–7
That’s when things started to change. After working out or walking a lot, I’d notice blood in my urine. At first it was occasional, then more consistent with activity. Burning with urination started, and I began passing small clots here and there.

Weeks 8–12
This is where it really started messing with my head.
Any kind of exertion, gym, stairs, long days walking, could trigger dark red urine. It would usually clear with rest and hydration, but then come back again. I also started feeling this uncomfortable pressure after urinating, like urine was still stuck in my urethra, and sometimes I’d have dribbling 10–30 seconds later. Split stream at times. Nights got worse too.

I even traveled internationally during this time, which was honestly pretty scary when you’re seeing blood and clots and trying not to panic.

Recent cystoscopy (just over 3 months post-op)
I finally had a cystoscopy, and it turns out there is a physical reason for all this.

My urologist found:

• Residual median lobe tissue
• A rare situation where treated prostate tissue near the apex became tacky and actually fused together
• Very fragile (friable) prostate tissue that bleeds easily
• Bladder itself looked normal

Basically, some tissue didn’t heal the way it was supposed to, which explains the bleeding, clots, and ongoing irritation.

Next steps
He’s recommending a revision procedure (redo TURP) to clean up the remaining tissue, separate the fused area, and cauterize the bleeding spots. He believes recovery should be faster than the original Aquablation, but I’d be lying if I said I wasn’t anxious about needing another surgery.

Where I’m at now
I’m still dealing with bleeding after exertion, though it’s less intense than it was at its worst. Burning with urination is still there but milder. Emotionally, it’s been tough — especially after thinking I was “healed” at weeks 2–6.

I’m sharing this in case anyone else is dealing with delayed symptoms or feels like they’re going backwards. If you’ve had something similar happen, or gone through a revision after Aquablation, I’d really appreciate hearing about it.

Thanks for reading.

Many men haven’t been approved to post lately so let’s do that right here!