I read many threads on Reddit prior to getting this procedure done. Quite helpful. So I wanted to convey my own story.
56 years old. Prostate about 75 g. Significant urinary issues for the past couple of years with poor stream, frequency, urgency… high IPSS score. Urologist felt that this would be a great option. The practice in Northern Virginia, for the past several years, has been doing the prostate artery embolism a few days before aquablation for two reasons: 1) help with decreased bleeding during the surgery 2) continued reduction of prostate size overtime. Decided to move forward, hoping to get good results like many have on this website.
Had the PAE on April 28. This procedure was fairly straightforward. Lasting approximately one hour. Initially when I arrived, IV was placed and I was taken back into the operating room. They obtained access via the vessels in the groin with local anesthetic and mild sedation was provided. Embolization was done to both the right and the left-sided vessels, but access was only obtained from the right groin. Went home approximately one hour after the procedure. 5 to 6 hours after the procedure, I began noticing that it was painful to initiate urination. I was told that this was going to happen because of the blood flow to the prostate being reduced. Definitely uncomfortable overnight but manageable with Tylenol. I was advised not to take any NSAIDs as I would be having the aqua ablation the following morning.
On April 29, I went in for the aqua ablation. After initial preoperative questioning and IV placement, I was taken to the operating room and under general anesthesia, the procedure was performed. I woke up in recovery with a catheter and continuous bladder irrigation. The catheter was larger in size and so extremely uncomfortable. The procedure lasted approximately one hour, and I was in recovery for an hour and a half. I went home with the catheter in place. It was very, very uncomfortable and painful. I kept hydrating. At this Urologist practice they do not keep patients in the hospital if there is no significant bleeding. I went home approximately 2 p.m.. getting home was very uncomfortable with the Catheter in place. Small tiny steps till I was able to get into bed. Any tiny movement would produce significant discomfort with the catheter. Till the following morning, I had to empty the catheter bag three times, producing about 6 L of urine. Thankfully, I did not notice any blood or blood clots, but the urine was orange in color because of treatment with pyridium , which helps to decrease pain with urination and the presence of the catheter. Overnight sleeping was very difficult because of this catheter in place. Had to wake up several times to empty the bag. My wife flushed it once before going to sleep. The following morning, even the tiniest movement I’m getting out of bed was painful because of the surgery and the catheter. My follow-up appointment was The next day at 11 a.m. and they had told me that if I did not have any blood in my urine and I was producing an adequate amount of urine, they would remove the catheter. I went into the office, and the catheter was removed. That, I have to say, was extremely painful. The pain lasted for about 10 or 15 minutes after the catheter was removed. I was asked to follow up in the office four hours later to see if I was urinating appropriately or if I was having significant post-void residual in my bladder. I spent the last next few hours just relaxing. And hydrating. My first opportunity to urinate, and I immediately noticed a huge increase in my stream. There was also significant urgency. I could barely make it to the bathroom. I did not notice any blood again the urine was orange-tinged. I kept hydrating and urinated several times. At the appointment in the morning, I was told that if I was not urinating well, then they would have to replace the catheter. The thought of that brought extreme fear to my mind. So I kept hydrating and thankfully appropriately urinating. The appointment at 3 p.m. they confirmed that my residual volume in the bladder was low and that I was good to go. That was such a relief. I could not imagine if I had to get that catheter reinserted.
For the past 5 to 6 days, I have just been hydrating. Primarily Tylenol for pain. Peridium as needed but trying not to use it. I have not noticed any significant bleeding and maybe am thankful that is because of the PAE procedure. Moderate significant pain on urination occasionally when starting, but typically when ending. Hydrating with about two or 3 L a day. For the first couple of days, I had very little control and needed to rush to the bathroom and occasionally did not make it before starting to urinate. Definitely the feeling of urgency. Stream is fairly strong. Needed to wear Depends diapers a couple of times when I was not close to a bathroom. As I use less and less of Peridium, urine is more yellow, but I have noticed a lot of froth or bubbles in the urine. Has anyone else noticed that?
Pain is only associated with urination. Also noticed that I was significantly constipated, the first four or five days. Had to take Colace and psyllium powder. Forceful bowel movement produced a lot of pain in the penile and pelvic area. Thankfully, that has subsided over the past couple of days.
For the first few days, I did not do much with respect to activity level. Four days postoperatively, I started going for small walks in the neighborhood. This morning, I went for about 30 minutes’ walk. When I initially started walking a couple of days ago, there was pelvic discomfort, but that is getting better.
Symptoms right now primarily pain on urination with urgency improving day to day. Have not noticed any significant blood. During the night, I have been having to get up about two or three times to urinate. But a few occasions have had pain from urination that lasted about 10 or 15 minutes. Pain primarily in the pelvic and near the head of the penis.
As well, as I mentioned, definite frothy foamy urine.
I asked my surgeon, and he stated that that was normal. Seeing if anyone else is experiencing that?
Hopefully, in the next one or two weeks, I can return to the gym and do some moderate amount of exercise. Hoping that the strong stream, which frankly I have not had for the last three or four years, continues indefinitely. Urgency has improved slightly, or at least the ability to hold the urine till I can get to the bathroom.
I will keep updating over the next several weeks as recovery progresses.