r/bph

I've been waking up 5 or 6 times a night due to prostate issues for years now, and finally hit a point where I need something more than Tamsulosin. I had a checkup with on urologist who recommended TURP after a cystoscopy, but I knew I didn't want to go that route so I got a second opinion. The second urologist did an ultrasound (the uncomfortable kind) and noted that my prostate really isn't big enough to recommend TURP, Holep or Aquablation, but he thinks TUIP would help. Since I'm only at 26cc but still experiencing a stupid level of nocturia, I wondered if anyone here had any experience with TUIP and what the whole process is like.

I am using ezetimibe as a prostate shrinker. Yes, I know it is not recommended for that, yes, I know there are no human trials. I am only in the first month so I don't know if it works yet. I am encouraged that there is no evidence of prostate atrophy, or sexual disfunction. I will report back from time to time to say how it is going. The reason there are no human trials, ( the computer says) is because there are other drugs, such as Dutasteride, made for this. These drugs, however have sexual side effects, so I want to try this.

Anyone experience this? I found out I have BPH, as an incidental finding on a CT to diagnose a bowel problem. They didn't even tell me actually, I requested the CT results.

I thought the flattened stools were a symptom of Inflammation in my rectum or elsewhere in my colon. Now I'm wondering if it could be due to my bulky prostate pushing into my rectum.

Does this sound familiar to anyone here?

I am a 71 year-old who had HOLEP4 months ago on a 260 cc huge prostate. I had suffered from various urinary and prosthetic symptoms for literally decades.

The surgery, which I had in Japan, actually,, was uneventful and painless, and apparently done with great precision. I have gone from massive numbers of clots, for which I was hospitalized twice with bladder blockage, and range of other related problems, to urinating forcefully, and without pain.

However, I did not ejaculate for four or five months prior to the surgery, because of concerns about exacerbating, bleeding related symptoms, and have not ejaculated for four months since the surgery initially to let the prostatic bed heal, and then subsequently because of anxiety about starting to ejaculate again after so long, particularly with the almost certain retrograde ejaculation.

I feel ready to try ejaculation again, and would be immensely grateful for any input from people here about their experience, about what I can expect, about how retro ejaculation is different,, etc.

Thank you so much for any input you can provide. . I am of course happy to answer any questions as well.

Had Optilume 11 days ago on April 27.
Not much pain from the procedure.
The catheter sucked but was removed on April 29.
No noticeable improvement until May 7.
I noticed fewer runs to the bathroom the last few days.
Last night, May 8, I only got up twice to pee.
My pee stream is still weak and dribbling also.
I feel my bladder emptying a little better.
Less urgency when I need to pee.
No further blood clots noticed.
Still sleeping in Depends as I fear leakage.
Doctor appointment on May 14 for flow test and possibly scope test.
Told best results in 3 months.
I am 71 year old male. I live in Las Vegas.
Only issue was enlarged prostate at 48.1 size.
Any comments or questions?

a decade of on an off bph symptoms let me hope that it would go away. i am a very young 60+ sportsman with zero problems in my life. therefore i thought that my body would heal it naturally. unfortunately the stream got weaker and weaker and i sometimes i even had to get up at night in order to pee.

what made me do nothing about it were intermittent periods of a stronger stream and normally i could even sleep for 8 hours without getting up.

but suddenly it worsened and i got the usual symptoms like urgency and weak stream whenever i was on an airplane or in a bus. i decided to do something about it. on a trip to south america i was completely blocked and i had to go to the nearest hospital to drain the bladder. the urologist recommended turp which i rejected because it is not permanent and it has many side effects. i asked him about holep but he could not provide it. the urologist recommended to leave the catheter inside for 10 days. i took it out after 2 hours and i could urinate with a weak stream and and i could almost empty the bladder. i started to research all holep operators worldwide. most did not even talk to me. i live in north america and i thought mexican holep operators are qualified and much cheaper. i experienced the opposite: they were hiding their experience and the price they quoted was much higher than anywhere else in the world. i also tried to talk to hospitals in thailand and in turkey. they all wanted to see extensive tests which i did not have at this time and they stopped talking to me when i could not provide that.

therefore i focussed on the usa finding out that there were only a few very experienced holep operators who do successful holep operations every week. i watched all available videos about holep leading to people like amy krambeck and others. i contacted everyone who i watched on youtube and who i found online. hardly anyone talked to me. only dr.austen slade who is one of the most experienced holep operators called me and answered all of my questions. i was impressed. after the call i researched his reviews and i saw that almost all of his operations were very successful and the people were very happy with the results.

i was asked to send the results of a pelvic mri to know the size of the gland as well as blood test, urine tests and an ekg. i did all tests and my gland turned out to be 200g which is extremely large. also the bladder showed to be distended on the mri. all other values were excellent. i was shocked. holep seemed to be the only option for an extremely large gland. i sent my studies to the office of dr.austen slade and agreed to an operation date and a price about one and a half months ahead.

i flew to boise on a monday in april. the next day i had a cystoscopy which was a requirement for the operation in order to investigate the bladder and the urethra. i felt no pain. no strictures were found and the bladder was looking ok with visible blood vessels from straining. after the cystoscopy i could not urinate. only some drops of blood came out. i was kind of blocked again but i hoped it would work again after a few hours and it did in a very weak stream.

the next day i had the holep operation in a surgery center in boise. everyone was very friendly, i was treated like in a spa. i was prepared for about one hour then i was given a spinal anesthesia which did not hurt either. i was given a monitor to watch the whole procedure which i appreciated. dr.austen slade had a student operator watching his procedure (i had to agree to that before the operation). he commented every step of the operation. i watched and listened the whole time. after the peocedure i felt already very well except of my legs being unable to move for more than 40 minutes. i was told that the operation was successful and most of the gland was removed (he mentioned the exact amount but i forgot how much it was)i got some food and some water and i could use my phone and my computer.

i had this nasty thing in my bladder. before the operation i was asked if i preferred to have it removed shortly after the operation or if i want to remove it the next morning myself in the hotel. i told him that would leave this decision up to him because he knew my situation and my anatomy. now i was told that it would be better to leave it in overnight and remove it the next morning. i could hardly sleep and the next morning the large bag was completely filled up with urine and blood.

i took the thing out and could only urinate a few drops. during the day the stream got a little bit better and finally in the evening it came out really strong.

it is now three weeks after holep and i can pee like a firehose from day two after the operation. the stream is much stronger than when i was 20 years old. i had no blood in the urine from day 2 to day 6 and only a little bit of blood coming out intermittently from day 6 to day 11, then it stopped. i bought urine pads at the recommendation of dr.austen slade but i never had to use it. i got zero incontinence, not even a drop. i did sports from day 10 and i started to walk fast and lift weights from day 14 because i am feeling great. at no point did i have any pain or even discomfort. i feel that dr.austen slade gave me my life back.

i am only writing my experience to help people in a similar situation.

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.

# # #

Wanted to make this post because other posts on reddit make cystoscopy way more stressful than it needed to be

Once you're prepped and in the room with the camera a nurse comes in a squirts numbing cream in your urethra, this burns a bit but not much more than getting soap into your urethra, while thats taking effect they are wiping down your area with brown liquid I think its called bacitracin.

Doctor came in and I didnt know we started for a sec, looked at the screen and seen her navigating my urethra.

When it gets to the prostate im not gonna lie, that ducked, it burns and hurts but it is so fast that before you have a chance to react to the pain she's past that part and the pain is gone

Scope hits bladder, she looks around and removed the scope

Entire procedure over in 30 seconds tops, took longer to check in and get changed for the appointment

Cant tell you what the pain is after yet, just got home but ill check back and update this post.

Hope this helps anyone else dealing with cystoscopy fears, its not bad

Update: maybe I've been lucky or maybe its the norm but I've had zero issues since the appointment. No blood burning or cramping like the discharge paper work and other stories I've read have said. I feel completely normal and have since the appointment and its going on 30 hours since. I have taken no pain meds since I got home yesterday so they certainly wore off before I woke up today. I hope my experience helps anyone feeling anxiety due to one coming.

Did anyone experience thin watery semen after HoLEP, also did anyone find their ejaculation became a dribble rather than a spurt.

I have read several posts here where people have mentioned having a Foley catheter inserted for extended periods of time. I'm curious how their doctors made the decision to keep the catheter in for so long.

The reason for my interest is I had been doing self-catheterization for the last 2-3 years, and only needed it on rare occasions where my bladder got overfilled and apparently pinched off my urethra, causing urinary retention. As soon as I self-catheterized and emptied my bladder, the blockage went away and I had normal (for BPH) flow again.

The first couple times this happened, before I learned to self-catheterize, I went to urgent care/ER and they inserted a Foley catheter and told me to come back in about a week. In retrospect that week long period was probably totally unnecessary for my situation, but they didn't know what was causing the retention at the time, so I think that's their default.

So I wonder, when a retention episode occurs do they have a good idea of what's causing it, and know how long the catheter needs to remain before the problem has resolved itself? Or are they guessing, and always use a worst case scenario?

I'd like to hear what various people have been told when confronted with this issue.

I thought it was a very low risk procedure but maybe not.

Hello - I had my PAE this morning. My appointment was at 7 EST and I went into the OR around 8:00 or so. I was not given sedation like I expected (thought I was getting similar sedation like I had with my colonoscopy). I was given valium and then local anesthetic for the femoral artery area. I didn't feel much as the procedure was happening - a little warmth here and there, but not much else.

Now, I was advised not to drink anything at least 6 hours before. I have dysautonomia, which requires that I stay fairly hydrated at all times. I usually have at least 60-70 ounces of water by 8AM, but I didn't have any before this procedure. Things were going great, but about mid-way, my body hit a wall and my BP and heart rate sank. The doctor was able to do one half of the prostate, but had to wrap it up as I was close to passing out. He said that I should still see noticeable changes in about 4 weeks or so. I'm currently resting and I'm not in any real pain at the moment. I'll follow up tomorrow and let you know how much that changes.

I'll keep everyone posted on my progress. Hope everyone is doing well after your procedures!

[non-professional view]

I feel that bph is clearly a lifestyle problem that modern life is making worse, so there should be lifestyle changes that we can make to help reduce it.

I've been looking at nutrition and supplements to investigate how these might help, if anyone has any thoughts or experiences please comment.

- vitamin D3. Seems related to bph, there was even a drug candidate a few years ago (BXL-628 - elocalcitol) that was a vitamin D derivative without one of the side-effects but it didn't make it (so far, anyway). Seems that the dose can be quite high initially, e.g. 6000 IU / 150mcg a day, but we should get blood levels measured over time to make sure it doesn't go crazy high.

- zinc and vitamin B2. I gather there's a case for not taking zinc every day, and vit B2 makes urine bright orange (depending on dose) so I'm taking these on alternate days atm. Something like 25mg per day for zinc (so 50mg if taking once every 2 days). Not sure what dose is best for vit B2, some are huge compared to RDA, but no real downside other than the coloured urine as far as I can tell.

- boron, 3mg / day and nettle root extract. Life Extension do a supplement with both of these in.

- blackcurrant seed oil (contains GLA - gamma linolenic acid).

- pumpkin seed oil - has many of the things we want, zinc, sterols, anti-oxidants, etc.

Also Saw Palmetto, Pygeum, etc etc, lots of options ...

These work on a number of different pathways, maybe one of them will make a difference? Supplement manufacturers make a variety of "prostate support" pills with different combinations of these and other ingredients. Note that some of them are physically quite large pills though. It seems to me that although there will be common factors, the key pathway / nutrient might be different in different people, so we might need several foods / supplements to have reasonable confidence in covering the problem. There's insulin & IGF-1, 5-alpha reductase, aromatase, androgen receptors, estrogen receptors, and on and on ...

Higher dose D3 seems an interesting option to me, has anyone tried this to help their bph?

I have often seen many things written about both. Medications, "They are band aid and will stop working eventually, you need to get surgery". Surgery," My procedure went fine, I wish I would have done it years ago", or, " Surgery was the worst option I picked, no improvement and I had to get it redone 5 years later". It would seem surgery would be a last resort since it is not perfect anyway.

Hello! I will be working closely with my dad‘s urologist and PCP, but was hoping for some guidance/advice for navigating things for my dad.

He is 80 and had a stroke right before covid, I’ve been his primary caregiver since. He has been on finasteride for the past couple of years to help manage BPH symptoms, and it’s been okay (trips to the bathroom every 90 min to 2 hours, helping him with the urinal at night about 2 - 4x depending). He is very well hydrated, so the number of times *almost* makes sense, but he does have a hard time starting, then has starts/stops/weak stream/not feeling like his bladder is empty.

This past week, though, we are taking him every 60 min and sometimes have to pull out the urinal before we make it to the bathroom. This has never happens before. Definitely increased frequency and urgency.

I have an appt scheduled with his urologist, who asked us to do a CT-ivp beforehand, and he will do a cystoscopy in a couple weeks.

In the meantime, our PCP started my dad on tamsulosin and tadalafil. Giving him the first doses tonight and tomorrow, respectively.

My question is: how do you determine whether to treat your symptoms with medications or with another intervention?

My dad is on blood thinners and has right sided weakness so of course I don’t want to put him through a procedure. However, even the previous bathroom frequency affected his QOL. Plus I don’t necessarily want to be in this position of asking this question 2 - 5 years down the road.

I will of course discuss this with his medical team but as a family we’re trying to decide.

If the meds work to alleviate his symptoms, is it even necessary to do the cystoscopy? Will the meds help shrink the prostrate enough over time, or should we be considering a Holep or ProVee (or whatever the least invasive option is)? PCP seems to be leaning toward using the meds while they work. Not sure what the urologist will suggest but was curious how you guys decided when to use meds vs a procedure since the posts here seem to be a mix of both.

thank you in advance!!!

I am 63 years old and on a routine ultrasound scan following remarks given for Prostrate "34 cc with intraprostatic calcific changes and intravesical bulge of median lobe 9.3". I don't feel any difficulty in urinating and don't need to get up for pee more than 2-3 times at night. However, I consulted a Urologist. He checked the prostrate and did urine flow check which was not good. He asked me to take Tamudra for 3 months. After 3 months another Ultrasound was done and the prostrate size was 27 cc and he again he checked urine flow and didn't find any improvement. So, he suggested for TURP and asked me to continue with Tamudra for 6 months.

Then I consulted another Urologist for second opinion. He did Cystoscopy and suggested Rezum.

As of now I don't have any discomfort other than little delay in starting the peeing. Do I need Rezum or TURP at this stage? Is Rezum totally trouble free or it can lead to some other complications. Second Urologist was saying after Rezum, I can get back to normal routine within 2 weeks. Is it correct? Please give your advice on what to do?

I have been diagnosed with BPH I have intermittent Blood in my urine. Urologist said it is common with BPH. I just want to ask how common is this? And every time I pee blood I ask myself if my Dr. knows what he is talking about! I have had every test done ct scan mri scans with contrast dye. My psa is 1.

I just need to know how common blood in urine is with bph? should I get a second opinion from outside my insurance provider Kaiser Permanente

Hi,

I had the Rezum procedure six weeks ago and have been taking 8 mg of Silodosin since 26 January (clearly due to retrograde ejaculation). I haven’t had any post-operative issues and I’ve booked an appointment with the urologist for next week. It seems to me that the situation (the flow) has improved, as has the issue with erections (I’m 58 and my prostate weighs 60 g).

I’ve read that giving up coffee also improves erections; well, it seems to have happened for me too, but I don’t know if it’s down to the coffee or something else.

I’d like to ask the urologist about Tadalafil 5mg? I admit I’m a bit embarrassed – we’re talking about health here, not sex.

Help! Any advice?

Here's the longer version of my journey: https://www.reddit.com/r/Aquablation/comments/1skl2q0/my\_bph\_and\_aquablation\_journey/.

It has been 4 weeks as of today. I am "fully functional" in all regard. I'm sleeping through the night most of the time, little or no blood now, good stream, and no incontinence issues.

After 6 months with a catheter, I expected a rougher recovery. I think I've had it easier than most.

I treat many men after HoLEPs and aquablations and wanted to share some intel on what I encourage for the first 3 months after said procedure.

1. Most men maintain too much intra-abdominal pressure throughout the lifespan. Add having prostate enlargement into that, with the urinary urgency and retention, and that pressure will continue to build. This puts a lot of downward pressure on the pelvic floor muscles.

2. Many men begin to have increased pelvic floor tension with BPH - they are often not aware of this. And performing Kegels to address the urinary dribbling will increase intra-abdominal pressure. Which makes urinary retention more likely.

3. After having a procedure to make the prostate smaller, many men will still subconsciously perform Kegels or embark on a Kegel routine. The opposite is usually helpful. We need LESS pressure in the system and we need more muscle relaxation in the saddle region to promote better urinary streams and sexual arousal.

4. Performing reverse Kegels are indicated after a prostate procedure. For those with a HoLEP, do this on the toilet to capture the pee. For thise with an aquablation or PAE, you will be less likely to lose urine when performing this and it can be done anywhere. Here is a video on how to perform a reverse Kegel:

https://youtu.be/lDkmi\_\_hEt8?si=qEIDpaSX2yBFBz09