Aquablation therapy uses a robotically controlled, heat-free waterjet to remove excess prostate tissue causing urinary symptoms associated with benign prostatic hyperplasia (BPH). The technology employs real-time ultrasound imaging to create a precise, custom map of the prostate, allowing for targeted tissue removal while attempting to preserve surrounding structures. This approach aims to reduce the common side effects associated with traditional surgical treatments for BPH. Understanding the post-procedure experience is important for men choosing this option.
The Immediate Post-Operative Phase
Patients awaken with a temporary urinary catheter in place to drain the bladder and allow the urethra to heal. The catheter ensures continuous urine drainage and often facilitates continuous bladder irrigation (CBI) to flush out blood clots or debris. CBI involves a steady flow of sterile fluid into the bladder through the catheter, which then drains out. Nursing staff monitors the urine color and output, which is typically pink or red initially. A persistent sensation of needing to urinate is normal, caused by the catheter’s balloon tip resting inside the bladder.
Most patients spend one night in the hospital for observation, allowing for monitoring of urine output and initial pain management. Discomfort, such as mild pelvic pressure or a burning sensation, is typically managed with oral pain medications. The catheter is often removed before discharge, usually within 24 hours, to confirm the patient can urinate effectively. If the patient cannot pass urine well, they may be discharged with the catheter in place for a few extra days.
Managing the Initial Recovery at Home
The first two to six weeks at home mark the recovery period as the prostate cavity heals. Mild hematuria (blood in the urine) is expected and can persist for several weeks, often fluctuating with activity level. Increasing fluid intake is the primary recommendation to help flush the bladder and keep the urine clear.
Urinary symptoms like frequency, urgency, and a mild burning sensation (dysuria) are common as the bladder adjusts to the newly opened channel. These irritative symptoms result from the surgical site healing and usually resolve gradually over the first two to four weeks. Physicians may prescribe medications, such as antibiotics or an alpha-blocker, to help manage these initial symptoms.
Activity restrictions are important during this phase to prevent bleeding and promote healing. Patients should avoid strenuous activity, heavy lifting exceeding ten pounds, and vigorous exercise for about one to two weeks. This includes running, riding a bicycle, or heavy yard work. Walking is encouraged six or more times a day, as it helps prevent blood clots.
Preventing constipation is also important, as straining during a bowel movement can increase pelvic pressure and potentially cause bleeding. Patients should follow a high-fiber diet, drink plenty of water, and may need to use an over-the-counter stool softener. Most men can return to light activities within one to two weeks, though full resolution of irritative symptoms takes longer.
Understanding Long-Term Outcomes and Follow-Up
The full therapeutic benefit of the Aquablation procedure is not immediate, as the irritated prostate tissue needs time to heal. While some patients report improved urinary flow soon after the catheter is removed, maximal symptom improvement is typically observed between two to three months following the operation. At this point, the International Prostate Symptom Score (IPSS) and peak urinary flow rate (Qmax) are expected to show significant improvement from pre-treatment levels.
Long-term studies show that the relief provided by Aquablation is durable, with sustained improvements and a low rate of needing a secondary BPH procedure at five years. Follow-up appointments are scheduled to monitor this progress, commonly occurring at one to two weeks, six weeks, and then at three and six months.
During these visits, the urologist assesses symptoms, measures the urinary flow rate, and checks for post-void residual urine volume. Monitoring prostate-specific antigen (PSA) levels is also routine, as the procedure can cause a temporary reduction in PSA due to tissue removal. This monitoring ensures the sustained effectiveness of the treatment.
Addressing Sexual Function and Potential Side Effects
A key advantage of Aquablation therapy is its minimal effect on sexual function. Due to the robotic precision and real-time imaging used, the anatomical structures responsible for erectile function are intentionally preserved. Clinical data indicates a low risk of new, sustained erectile dysfunction (ED) following the procedure, with many studies reporting no impact on erectile function scores.
The most common sexual side effect after any prostate surgery is retrograde ejaculation, where semen enters the bladder instead of exiting the urethra during orgasm. Aquablation has a significantly lower rate of this side effect compared to traditional transurethral resection of the prostate (TURP). Clinical trials show that a small percentage of sexually active men experience retrograde ejaculation after Aquablation, which is not medically harmful.
Patients are advised to abstain from sexual activity for four to six weeks to allow the prostate capsule to heal completely. This waiting period prevents trauma to the surgical site and minimizes the risk of bleeding. Once healing is confirmed by the physician, men can safely resume sexual activity.