My BPH Experience

January 25, 2023
My first experience with a urinary issue arrived unexpectedly when I was 31 in the form of a knee buckling, crying uncle, get to the hospital asap – kidney stone. Being recently married, I had brought my new bride to an unfamiliar city since I couldn’t relocate with my job. As darkness fell one foreboding evening, I found myself desperately trying to crawl into the front passenger seat of our vehicle while moaning and screaming like an inconsolable cat in heat while our neighbors’ porch lights came to life one by one to see what all the commotion was. As I nestled into the fetal position and attempted to give directions to the nearest hospital, my wife found it hard to compute which direction was north, south, east, or west and certainly didn’t know street or road names yet. Luckily for me, she knew which direction the mall was, so I used its location as our guiding light to the hospital. As I found out later when the kidney stone passed, it wasn’t just a run-of-the-mill concretion. It was a super-sized, glacial-moving, knife-wielding mass that made Freddy Krueger look like a saint. Trying to pass it through my ureter was a feat akin to giving birth some say. I was fortunate that it moved on and out within a few days and not weeks. Little did I know that this was just the beginning of my very long journey with urinary mayhem. Another issue – an enlarged prostate or benign prostatic hyperplasia (BPH) and its resulting lower urinary tract symptoms (LUTS) took over the reins in my late 30s and has been driving the bus ever since. Having endured 20 years of BPH symptoms that gradually became as bad as they could get, I was more than ready for lasting – and hopefully permanent relief.

My Early BPH Experience

In my mid to late 30s, I began favoring the option of making a few additional trips to the restroom each day. Nothing too out of the ordinary, and I certainly didn’t HAVE to, but I felt more comfortable making the extra “pit stops”. This went on for a couple of years until I was about 40. Then it became a little more involved than simply adding a few additional pauses in my day. I started making sure that if I saw a restroom or had a chance to take a restroom break – that I took full advantage since I wouldn’t always be near a restroom and it would allow me a full “range of motion” throughout the day without having to actively search out a restroom if the urge became too strong. Looking back now, benign prostatic hyperplasia had already started making its mark both physically and psychologically. Because of my dad’s history with prostate issues, where he was consistently in the hospital with kidney stones, BPH issues, or prostate cancer, I requested that my PSA be checked each year starting at age 36 during my annual checkup so I could start keeping track of my yearly PSA numbers and their velocity (how quickly they changed). My first PSA reading was 1.0 when I was 36, but by the time I reached 40, it had risen to 1.5 – a 50% increase in 4 years.

My Mid-Stage BPH Experience

From about 42 to 49 years of age, my BPH symptoms gradually became more noticeable and they started suggesting additional lifestyle modifications that I would need to consider adopting. Benign prostatic hyperplasia was now telling me that I could no longer hydrate the way I used to because drinking too much water meant even more trips to the bathroom. I began getting up at night a time or two to use the restroom and I noticed I felt most comfortable taking a restroom break every 3 to 4 hours during the day. In addition to proactively using the men’s room whenever I saw one, I also noticed that I wasn’t completely emptying each time I urinated. Sometimes I felt the need to go again a few minutes later or a short time after. During this time, I also began starting and stopping or hesitating during urination, and my urine stream had noticeably weakened; neither of which I had experienced before. In addition to my PSA numbers jumping from 1.5 to 5.6 during these seven years, I found myself having to endure some urologic tests such as a urinalysis to rule out a bacterial infection, a cystoscopy, and transrectal ultrasound to check my urethra and bladder, a post-void residual volume test to determine the amount of urine left in my bladder after urination and finally a uroflowmetry test to discover how quickly urine was being released. Such a hassle I thought. But much more was yet to come.

My Late-Stage BPH Experience

Around age 50 my BPH symptoms became both more noticeable and bothersome. I had to make more substantial lifestyle changes, including how much I drank at any given time, especially in the evenings before bed, and the types of food and beverages I ate and drank. My bathroom trips were now every 2 to 3 hours during the day and I would typically get up 3 to 4 times during the night. By the time I reached 54, I was using the restroom every one to two hours during the day, and some nights I felt the urge to get up 5 or 6 times to use the bathroom. I had already endured two prostate biopsies a few years apart, so luckily prostate cancer was able to be ruled out. My first ER visit for full urinary retention (very painful) was this same year and I was told I narrowly escaped serious injury as the nurse placed a catheter and released all of my dammed-up fluids. A year and a half later, at an out-of-state funeral for my best friend who passed away unexpectedly at 55, I again found myself in the ER having another catheter placed to fix my full urinary retention. I ended up missing the funeral because of BPH. When I turned 58, everything went south. I was so ready to be rid of BPH. After watching my PSA climb to over 20 and enduring two painful prostate biopsies while nervously waiting for results, I was at the end of my rope. Countless trips to the bathroom every day, years of lost sleep, dictated changes in my living, running, and swimming routines, numerous tests, and re-tests, having to learn how to self-catheterize after two ER visits, and then needing to self-catheterize up to 3 or 4 times some days to be able to go to the bathroom at all, I had finally had enough. It was time for action.

Why I chose Aquablation

I strongly suspected I had BPH when I was in my mid 40’s. My doctors thought I may have benign prostatic hyperplasia as well. So, I have had over a decade to figure out what I wanted to do about my BPH – if or when it got severe enough that watchful waiting and medication were no longer effective. I tried watchful waiting for about 10 years, but I was never a big fan of BPH medication since numerous side effects don’t appeal to me, including lightheadedness or disorientation when standing up, a stuffy nose, retrograde ejaculation (RE), and more symptoms depending on the type of medication taken. Since my father developed prostate cancer in his late 60s, I decided early on that it was too risky for me to take 5-alpha reductase inhibitors (5ARIs) that shrink the prostate over time since one side effect includes an increased risk for high-grade prostate cancer. So, my BPH medication of choice was alpha-blockers which would relax my prostate and put less pressure on my urethra. I discovered that some days the alpha-blocker I was taking helped with my benign prostatic hyperplasia and some days it didn’t. With an ordered MRI scan and subsequent diagnosis of a 200-gram median lobe prostate (one lobe of the prostate grows up into the bladder), it’s no surprise that the two alpha-blockers I used at different times weren’t as effective for me since much of my prostate grew up into my bladder and was blocking urine flow from my bladder as well as my lower prostate growth blocking flow through my urethra. The alpha-blocker worked on my lower prostate and urethra issue, but it wasn’t able to help with the median lobe growth up into my bladder which was often blocking flow from getting out of my bladder in the first place. Thank goodness I learned how to self-catheterize after my two ER visits. I had years to perform my due diligence and I invested a good deal of my spare time researching ALL of the available benign prostatic hyperplasia therapies and possible cures for BPH. I am still fairly young, so I wanted my cake and to eat it too as the saying goes. I was encouraged by my in-town urologist and his partners to get the robotic-assisted simple prostatectomy (RASP) procedure since their group performed it and had done hundreds of procedures. They said it would last me a lifetime without ever having to have my prostate worked on again. However, their description of coring out my prostate like the inside of an orange and simply leaving the rind behind didn’t appeal to me. What about the important nerves and ducts that regulate sexual function? I was told they couldn’t be spared in the procedure they would perform. The fact that I would have retrograde ejaculation and possibly other sexual issues for the rest of my life was not what I wanted. I had already endured 20 years of BPH and I wasn’t about to settle for second best. My urology group also performs Urolift in their office, which employs surgical implant “lifts” that separate the prostate from the urethra and give easier urine passage. However, the guidelines stipulated a maximum prostate size of 80 grams for the procedure. I think it is now up to 100 grams since I first looked into it. However, since my prostate was twice as big at 200 grams, I didn’t qualify. I also didn’t like the idea of implants being left in my body since some men have had them come loose and they have to go in again for repair work so to speak. Then there was laser therapy for benign prostatic hyperplasia which introduced damaging heat which could cause some undesirable sexual side effects. I also considered prostate artery embolization (PAE), where microspheres are delivered into the vessels supplying blood to the prostate, and when blood flow is cut off, the prostate reduces in size. However, a patient is subject to a lot of radiation (up to a couple of hours) before the procedure is finished. I wasn’t willing to expose myself to that much radiation and risk other issues down the road. Also, what if the microspheres traveled elsewhere in the body? There had to be a BPH procedure that gave me everything I was looking for, had no sexual side effects to speak of, and didn’t introduce damaging heat, butchery, or radiation. I kept buying my time, dealing with my BPH symptoms the best I could, and waiting for science to catch up with my requirements. Finally, over the last few years, I was able to read studies, research, and trials about Aquablation – a BPH procedure that checked off all of my boxes, was FDA-cleared, and would be heat and radiation-free. I had finally found the perfect BPH procedure for me! Well, not so fast – as my medical insurance provider would say. It seemed they wanted me to undergo RASP or a simple prostatectomy to address my benign prostatic hyperplasia. They said those procedures had been used for decades and were the go-to procedures for large prostates like mine. I told them I wanted Aquablation and that it was FDA-cleared, which means that they should cover it. They said I would have to have my out-of-town urologist apply for approval, which he did. However, the request was denied. I was about out of time on my medical policy, so I temporarily threw in the towel. I would soon be switching medical plans due to a job change, so I would just wait 4 months until my new medical plan took effect. Just my luck…the new company uses the same insurance provider. So, I again had my out-of-town urologist request Aquablation. Again, a month later I was denied. I had had enough of the insurance company and its two denials. This time I wanted to make it stick. I contacted PROCEPT-BioRobotics, the manufacturer of the AquaBeam robotic system that performs the Aquablation procedure. The executives there mentioned they had recent successes with more than one insurance provider agreeing to the Aquablation therapy for both requesting policyholders and as blanket authorizations, so I enlisted their support with documentation and the best way forward. I appealed my insurance provider’s 2nd denial with all of the supporting documentation from PROCEPT-BioRobotics and a month later I was finally approved to receive the Aquablation therapy. Yea!!! Only, I still had more hurdles to jump. I was only given 3 months in which to get the Aquablation procedure performed or I would lose the chance and have to appeal again. I was scheduled in mid-June 2022 to get Aquablation performed, but with my luck, I caught covid after a family trip. So, I had to postpone the procedure. Then I was scheduled for early July, but when I traveled to the hospital three hours away from my home, with my parents in tow, the hospital told me 10 minutes after arriving that their systems were down and I would have to come back days later. So, I rescheduled for mid-July and was finally able to have the Aquablation procedure performed just a few weeks before my time ran out. Whew! The Aquablation therapy went very well. From the easy-as-could-be spinal anesthesia, which allowed me to remain awake and ask questions of both my doctor and the PROCEPT-BioRobotics representative during the entire procedure, to the pinpoint guided mapping of my prostate resection by Aquablation’s robotic heat-free water jet, I don’t think another procedure could have gone any better. My recovery and subsequent release a day later from the hospital had me back home within a day. I don’t think I could have asked for any better transparency or ease of procedure than what I experienced with Aquablation. And the fact that I had such a large 200-gram prostate and I was able to retain all sexual functionality and very few side effects is no less than a scientific miracle in my eyes. I was able to have my cake and eat it too. And to think that I will be able to enjoy a full life for years and hopefully decades to come without BPH symptoms is exciting and liberating. I now have my life back the way I want it. I had been at the end of the line. I was trying to grasp the very last straw. I had to do something at just that moment in time or suffer decompensated bladder damage and possibly have to live with a permanent catheter for the rest of my life. I am fortunate to have had the time and foresight to proactively perform a decade of research in preparation for my decision. And once I chose to address my benign prostatic hyperplasia through Aquablation I had the full backing and support of both my out-of-town urologist, whom I hand-selected to perform the procedure, and management at PROCEPT-BioRobotics who developed the AquaBeam robotic system that would be my saving grace. As I write this, I am nearly 5 months post-op from my Aquablation procedure. Almost immediately after my therapy, I could urinate like a teenager again. It still holds today. The flow volume is off the charts compared to what I suffered through for over a decade. I have retained full sexual function with no issues whatsoever. Everything is working the same or even better! Now, I can go half a day without using the restroom and I can sleep all night long if I want without going to the bathroom (although by habit I sometimes get up once during the night for old times’ sake). If you have a large prostate like me (really anything over 100 grams) and you don’t want to be exposed to radiation, damaging heat, or prostate coring, there aren’t many choices that will lead to such an overwhelmingly positive outcome if you want to retain all sexual functionality with minimal side effects. I had a huge prostate and because I am very physically active with running, swimming, biking, and lifting, it is taking me a little longer to be able to run again since running is a very jarring physical activity and I had 70% of my prostate removed during Aquablation. There is still some healing to do for me since I do remain active and I didn’t just sit on the couch for a month after my procedure like my doctors likely wanted me to do. I have also experienced some very, very minor stress incontinence that occurs sometimes when I sit for an extended period or bend down. I am working on pelvic exercises to remedy it, but compared to what I faced if I hadn’t had Aquablation performed, it’s an extremely minor temporary inconvenience and will get better and likely go away completely over the following months. It happens with many BPH procedures and is likely less of an issue with smaller than 200-gram prostates. I can say without a doubt or any hesitation that no matter what your prostate size is, Aquablation can deliver all of your expectations and desires for a positive outcome for eliminating LUTS brought on by BPH. If the desire is to retain all sexual functionality, be able to urinate like a teenager again, stop all the dribbling, starting and stopping, hesitation, incomplete emptying, urinary retention, avoid radiation, heat, and the coring out of the prostate, then Aquablation may be the right solution for your BPH issues…just like it was for me. Good luck to all who read this and I wish only the best for your particular BPH situation. I’m thankful I found Aquablation and I’m grateful for the scientific minds and excellent management at PROCEPT BioRobotics that dreamed up, designed, manufactured, and made available to the public such an ingenious and life-altering medical device for addressing benign prostatic hyperplasia. It has made a world of difference in my life. Aquablation therapy patient Chris. Individual results may vary. There are risks associated with any surgical procedure. Talk with your doctor about these risks to find out if Aquablation therapy is right for you.

All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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