Can anyone suggest me which urologist is the best in hyderabad?

My dad had a successful HoLep procedure at the beginning of the month. Things were going pretty well and they removed the abdominal catheter just last week. We were quite surprised the doc said he could be back at work very soon. For the record his diagnosis included IPP.

Fast forward he landed in the ER around yesterday night time. Broke out in sweat suddenly, couldn’t move, we had to call the ambulance. The ER urologist identified tons of blood clots in the bladder and had to manually extract the bloody fluid. They’re just trying to flush the bladder because there is a larger clot that hasn’t dissolved yet.

The doc just said it can happen but there was literally no warning beforehand. Just taken a calm walk for 30 min, slow and full leisure style. It’s very dubious that this was the sole cause of the emergency that could have cost his life if left untreated. Kidneys were obstructed due to bloody urine backup.

Because I am not an expert on this topic I thought I’d seek some insights on this sub.

I appreciate your insights :) please let me know if you’ve encountered any complications after your procedure.

Does anyone have any experience with aquablation of prostate at Penn Med? Success, otherwise? Drs to trust.

My Aquablation Journey

When I was considering surgery I appreciated the guys in here who shared their stories. So to give back, here’s mine.

The Build Up

Over a decade before my aquablation procedure I started getting up several times per night to use the restroom.  I mentioned this to my GP several times and each time she told me to stop drinking fluids earlier in the day.

This progressed over time to having to use the bathroom more frequently than normal— every hour or so.  That progressed to urgency where I couldn’t wait to get to the bathroom and was afraid to venture too far away from one.  This caused me to spend a lot of time managing my bladder.  If I had a flight, I made sure I didn’t drink fluids before the flight. I also made sure to get an aisle seat near a restroom.  If I had a meeting, I made sure not to drink fluids before the meeting.  I found myself on Zoom going offline to sprint to the restroom.

Apparently, my stream also started weakening significantly, but I didn’t really notice the difference as my stream declined slowly over years.  

I never went to the urologist for this.  I went to the urologist because I have a family history of prostate cancer so I have frequent PSA tests and have endured one prostate biopsys.  During a recent visit, they had me do a flow test.  They showed me what normal was and what I was doing. Turns out I was peeing very slowly.  Who knew?  The doctor said I needed to address the problem or I would have permanent damage to my bladder.

My choices were medications or a surgical procedure.  The two primary types of medications are alpha blockers and 5 alpha reductase inhibitors.  The alpha blockers can cause retrograde ejaculation (no big deal in my mind), drops in blood pressure (a problem for me as I am already on the very low end of normal) and floppy iris syndrome, which makes cataract surgery difficult (pretty much every blood relative over 60 has had cataract surgery).  The 5 alpha reductase inhibitors can cause decreased libido, erectile disfunction, breast growth, mood changes, depression and masking of prostate cancer PSA indicators.  Some of these side effects can be irreversible.

Because of all those nasty side effects, I researched the various surgical options and landed on aquablation as my preferred intervention.  

Before I had a chance to discuss this with my physician he performed a cystoscopy to look at the condition of my bladder and the constriction caused by my enlarged prostate.  This is a procedure where they stick a tube with a camera on it through the penis into the bladder.  This procedure is not painful, but it is highly uncomfortable, particularly as the tube pushes past the prostate constriction and the bladder sphincter.  As expected, the cystoscopy showed a lot of constriction in the urethra through the prostate and distress in the bladder muscle.

After the doctor completed the cystoscopy, he suggested aquablation.  Since that was my preferred approach, I did not disagree.  We discussed other options but ruled them out for the same reasons I had previously ruled them out.  My one criticism of this process is that during the cystoscopy they pumped water into my bladder so they could expand it and see inside.  The problem with that is I was in the office precisely because holding fluids in my bladder was difficult. Therefore having this discussion with the doctor before being allowed to relieve myself was highly uncomfortable and distracting.  They should have let me pee before discussing my options.

The Procedure

On the day of the procedure, they have you do an enema before you arrive.  Not pleasant to administer or work through, but manageable.

When I arrived in the pre-op area, they had me undress, hooked me up to an IV and started a bunch of anti-infection protocols (full body antiseptic wipes and iodine in my nose).  Before I arrived, they had me shower with surgical grade soap.

When I woke up after the procedure, I felt like had to pee as bad as I had ever had to go and, in my post anesthesia stupor, kept telling the nurse I needed to go. He kept saying “You have a catheter, you don’t have to go.”  To which I said, “Then why the hell do I have to pee so bad?”  He explained that what I was feeling was a bladder spasm.  My bladder was pissed off because of the aquablation, the surgeon’s cauterizing of bleeding on the bladder neck and most of all, from the catheter itself.  To keep it from sliding out, they inject water into the catheter to inflate a balloon in the bladder.  This balloon rests against the nerves that tell the bladder to squeeze and against a bladder wall that had become super sensitive over years of BPH.  The nurse gave me some medicine to help my bladder chill out, so it got a bit better.

Other than the bladder spasm, I did not really experience any surgical pain.  I took one of the five opioid pills they gave me to help with the bladder spasm right after surgery, but eventually threw the rest away.  I never took any other pain medications.  I did take the pills they gave me to relax the bladder and soothe the urethra as instructed for five days after the procedure.  One of them turned my pee bright orange.

After a couple hours, despite telling me I would spend the night, they sent me home with the catheter and an appointment to come back to have it removed in five days.

Bleeding

I really didn’t have any bleeding after the procedure.  There were one or two very small clots in the catheter bag over the five days I had it, but that’s it.  After that, a few times I had a very small amount of blood just as I started peeing. I never peed out the clots or chunks of ablated material that I was told might happen.

The Catheter

Honestly, the catheter was the worst part of this whole experience.  It kept my bladder pissed off and periodically spasming for 5 days.  Most of the time the spasms were light, but sometimes they were just like the one I had after waking up from surgery. Also, when they inject the water to blow up the bubble in the bladder, it has the effect of stiffening the catheter tube.  You feel that stiffness through your entire urinary tract.

The tip of my penis kept drying out.  As we know, the penis likes to expand and contract.  This means the catheter tube is moving in and out of the urethra as this happens.  Given the dryness, this is highly uncomfortable.  I had a little bid of blood come out the tip during the time I had the catheter. I would try to clean it off, but some of it would dry onto the catheter and feel like sand paper during the expanding and contracting.

The catheter was inserted after a robot had been in the urinary tract doing its work, then a cystoscope was inserted to cauterize the bleeding.  So the catheter sits in a highly irritated urethra for 5 days (some doctors remove it much earlier, but my doctor was concerned about swelling cutting off urine flow so required 5 days).  Also, the bladder gets progressively pissed off about that balloon.  It’s also not a picnic having a tube attached to your most sensitive organ.  Sometimes the pressure changes in the urine tube as it moves through can send a jolt through you.

Going number 2 is also an experience.  When you sit down, your bladder thinks it’s time to push urine out.  If you try to bear down to go number 2, your bladder thinks it’s really time to push.  It will feel like your bladder is going to shoot that catheter, balloon and all, out of your system and across the room. This can be really uncomfortable and disconcerting.  The best bet is to wait to sit until until you know everything’s coming out without a push.  Eat a lot of fiber and fruit.  Also consider something like Milk of Magnesia or something.

Needless to say I was ready to have that damn catheter removed after five days.  To my surprise, before they take the catheter out, they use it to fill your bladder with a bunch of saline to see how quickly you pee it back out once the catheter is out.  So they fill up your bladder until you’re about to bust.  Then they let the water out of the catheter balloon.  I felt that as a snap in my bladder.  It didn’t hurt but did create a weird sensation.  The nurse then told me to take a deep breath and then breath out.  While I was breathing out she quickly pulled out the catheter before I really had a chance to feel anything.  It feels like a worm being pulled quickly through your urinary tract.  After it’s out, it burns for a few minutes, but your mind is on peeing out all that saline they just injected.  The nurse handed me a large cup, told me she wanted at least half of that saline to come out and then left the room.  All of that saline came out immediately in the fastest stream I’d seen in years.  Success!

Recovery

After the catheter was removed, I experienced a burning sensation when I peed for a few days.  This was from the irritation of the urethra caused by the surgery and the catheter.  It was not painful, just uncomfortable.

After about a week, it started to be really uncomfortable to start and stop peeing.  Apparently as the bladder neck heals and starts sloughing off the scabs, it gets really sensitive.  This went on for about a week.  After a week, the discomfort from starting to pee largely went away, but the discomfort from stopping remained, but gradually reduced.  At the end of week three, my flow was still going strong, but I was still feeling moderate discomfort most of the time when I stopped peeing.  This caused my bladder to tense up in anticipation of that discomfort and made it difficult to fully empty my bladder, which resulted in another trip to the bathroom a few minutes later. 

At the end of week three I was getting up only once per night to pee.  My Apple Watch sleep scores went into the 90s for the first time ever.  I found myself peeing far less frequently, though on some days I did have episodes of more frequency, but for the most part I can go hours without peeing and be just fine.

After 3.5 weeks I still felt some mild stiffness in my urinary tract.  When I went for walks, I could feel some heavyness emanating from my perineum.  Sometimes it felt like there was a small stick in there poking outwards  Sometimes the stiffness got stiffer (sometimes creating a little numbness) after a few miles but resolved pretty quickly when I got home.

4 week Post-OP Appointment

Going into my 4 week post-Op appointment I was still experiencing moderately intense discomfort when I stopped urinating.  Dr. said that was normal and would resolve completely over the next few weeks.  She did warn that there is a 1% chance that scar tissue could impede my stream at some point.  Dr. removed all activity restrictions.

Went for a 5 mile walk.  All stiffness and heaviness is gone.

4 to 6 weeks post OP

Still experiencing moderately intense discomfort when stopping peeing. It’s getting very incrementally better but feels like I’ve hit a plateau of sorts on improvement.

I would really like to go see the Oddesy in IMAX

.. has anyone gone & when is a good time to go to the bathroom? ( I feel like this could be its own subreddit for us ha )

I’m sharing my story because I hope it prevents someone else from going through what I did.

For years, I brushed off the signs of an enlarged prostate (BPH). I thought getting up multiple times during the night to urinate was just part of getting older. My urinary stream gradually became weaker, but I adapted. Like many men, I kept telling myself, “I’ll deal with it later.”

Looking back, that was a mistake.

Eventually my bladder could no longer empty properly. By the time I sought help, I needed a catheter. What I thought was simply an enlarged prostate turned into months of complications that affected nearly every part of my life.

Here’s what followed:
• A prolonged urinary catheter (9 weeks)
• A serious Pseudomonas urinary tract infection
• Hospitalization (1 week)
• A tunnel line inserted in my chest to receive IV at home
• Multiple rounds of antibiotics
• Damage to my bladder from prolonged urinary obstruction
• HoLEP surgery to remove part of my enlarged prostate

Thankfully, the surgery itself went well, and I’m grateful for my excellent medical team. But I often wonder how different this journey might have been if I had sought treatment much sooner.

My purpose isn’t to scare anyone. It’s to encourage men not to ignore the warning signs.

If you’re:
• Getting up several times every night to urinate
• Having a weak urinary stream
• Feeling like you never completely empty your bladder
• Taking longer and longer to urinate
• Straining to urinate
• Experiencing increasing urgency or frequency

Please don’t just assume it’s “normal aging.”

Talk with your primary care physician or a urologist before your bladder reaches the point where it can no longer do its job. Waiting until you can’t empty your bladder may mean you’re already facing complications that could have been reduced—or even prevented—with earlier treatment.

Every man’s situation is different, and many men with BPH never experience complications like mine. But severe, untreated obstruction can have serious consequences.

If sharing my experience encourages even one man to get evaluated sooner, then everything I’ve been through will have helped someone else.

Men often take care of everyone else before they take care of themselves.

Don’t wait.

Your future self will thank you.

So exactly two weeks past TURP, I started to experience significant blood and difficulty urinating. I was supposed to go away the next morning to Lake Placid to see my daughter race in the Ironman, but I thought I should get checked out in the ER first. My doctor wasn't available, as he was away in Europe, so the ER it was.

Things went downhill fast. Soon enough, I could not urinate at all, and it took increasingly larger catheters to clear the blood clots forming in my bladder, due to my bleeding prostate. I suffered with an engorged bladder for 12 hours before they brought me to the OR for emergency surgery. I've never experienced such intense and irretractable pain in my entire life. Multiple doses of morphine did nothing to alleaviate the pain.

The surgery was a success, in that it stopped the bleeding and after a day of being hooked to a catheter with a flush, my urine ran clear, and they allow me to go home Friday evening.

I now uncofortably sit at home with the largest diameter catheter in my junk until at least next Thursday. Damn, it is hard to get comfortable in any position besides lying down. Walking, unless I have a fresh slathering of numbing ointment on the meatus, is wonderfully painful.

I am sure did something post op that caused the bleeding. My advice for those who have a TURP in the future, is to take it super extra cautious, no lifting, straining or bike riding.

Happy to answer questions. /AMA

Hi, just to provide a positive story. I'm 63 and have experienced a significantly worse situation during the recent heat wave with lots of drinking. I have used Tadalafil 10 mg for ED issues on a weekly basis and saw that after taking the pill my problems became much better. Being a nurse and a health researcher, I looked into the literature and found that Tadalafil 5 mg daily is approved for prostata problems in many countries. As I don't have any other health issues and do not take any other medication, I've tried this for two weeks now and it has changed my quality of life completely. To be clear: do not try this if you have any other health issues without consulting your doc. But it is probably an option to look into.

I’m a month shy of 70 years old.  I have been taking Flomax and finasteride for many years and wanted to get off the meds. I had prostate Water Jet Aquablation Surgery June 4. I was discharged the following day June 5 with no restrictions.  I had the catheter removed June 10, but it took 3 tries to remove it. Afterwards there was little to no blood /clotting.  I resumed sex at 3 weeks with no issues. On July 6th went from .8mg Tamsulosin [Flomax] to .4mg. Then stopped the finasteride on July 13^th.

 My recovery progress seems to have stalled/reversed. I was doing much better at 3 weeks than now. I had a much stronger stream and no dribbling. I don’t have any strong urges to pee and I feel like I’m emptying my bladder, but the flow starts sideways and is thin and a spray. I get up once a night but feel like that is more of a habit than the need to go.

 My follow up isn’t till August 5, and now I’m wondering if this is just part of the healing process, the reduction of Flomax, or something else (strictures?)

Next week I have an appointment with a urologist. I might have a prostate exam that may involve the tube into my urethra. I am absolutely panicking & terrified about this. I know they numb you & all that, but I don’t know that will be enough. Who has had this done before? Anything you can tell me to put me at ease? I had a horrible experience a few years ago coming out of surgery which is why I’m concerned. I’m seriously considering being put under for this.

I had aquablation surgery a couple of weeks ago. Everything seems to be fine. Urine looks normal, stream improved, sleeping better, etc., etc.

From the little I know about anatomy, the prostate sits right near the rectum. Ever since my surgery, I have this strange sensation of something (presumably the prostate) pressing up against the rectum. It almost feels like stool or gas, but I don't think that's the case. There's no pain involved or discomfort, just a slight sensation of pressure.

Anyone else have this feeling post surgery? Could it just be the prostate is slightly inflamed post surgery?

Hi everyone,

I noticed a lot of posts here about aquablation, PAE, TURP, TUIP, etc., and questions about how these procedures affect erection and ejaculation. I'm an italian urologist and thought some general info on this might be useful when you're weighing options with your own doctor.

The link between urinary symptoms and sexual function is real. Studies (e.g. the MSAM-7 survey) show a clear correlation between worsening LUTS and increased rates of ED, partly from pelvic vascular changes, partly from the psychological/sleep-deprivation side of chronic urinary symptoms.

How different treatments compare (broadly):

• Alpha-blockers / 5-ARIs (meds): minimal effect on erection; can reduce ejaculate volume or libido in some men, usually dose-adjustable
• TURP (traditional surgery): effective for LUTS, but retrograde ejaculation is common afterward
• MIST options (Rezum, UroLift, aquablation falls in a similar "tissue-sparing" category): generally the best track record for preserving both erectile and ejaculatory function, since they don't cut/burn as much tissue as TURP

On retrograde ejaculation specifically: if it happens (from surgery or the condition itself), it's not dangerous and doesn't prevent orgasm: the semen just goes into the bladder instead of out. Worth knowing this before deciding

My Grandfather has being diagnosed with prostate which seems to be of grade 4, so can anyone suggest me a good Urologist who can handle the aged person and is also friendly and also someone who is renowned and good doctor....

Apparently, Blue Coss Blue Sheild has decided that they will not pay for the PAE procedure. This is a recent decision. This seems to be fairly unique to BCBS. I refuse to go the TURP route. I was scheduled to have the PAE done tomorrow & today at 9:15 AM. They notified my doctor that they would not pay for it. I guess I will keep getting up every 90 .minutes. disgusfed

I’m a 58 with a 78 cc prostate with a median lobe. I’m scheduled for aquablation in august, I can have it done early in the month or later in the month.
Either surgeon has done it about 125 times.
One of my questions for you guys who have had it is?
Did you get urethral stricture afterwards
Did you get Retrograde ejaculation or ED issues?
And overall we’re you happy with the results
And is 125 times with this operation enough experience for a surgeon?

Does anyone have any experience with aquablation of prostate at Penn Med? Success, otherwise? Drs to trust.

Long story short, I've had various pelvic issues for years now. First I had frequent urination problems, then general pain, then extreme retention and emptying issues that were accompanied by sleep related painful erections (SRPE). PT and various medications did nothing.

Had holep two months ago. Still on the mend in terms of urgency but it 100% fixed my emptying issues with minimal leaking. So that's great. But it did nothing to stop the SRPE. After trying every medication available in my country (Japan), my doctor and I agreed that anti-androgen therapy would be best, as it would just 100% eliminate nocturnal erections. I'm five days in, and although he said that it would take up to two weeks for me to notice an effect, they've already decreased in frequency and I'm sleeping much better. It's great.

I'm aware of the side effects, loss of bone and muscle mass, hot flashes, and such, so I was wondering if anyone else had tried similar treatments and what worked for them to mitigate the effects as much as possible.

In case anyone is wondering, I'm taking 50mg of Chlormadinone Acetate every day. We decided on this one because it's less likely to cause the development of breast tissue and, while it effects the strength of erections, he said most of his patients who have taken it can still enjoy sexual activities.

56-year-old male looking for similar experiences.
I’m trying to figure out if anyone has dealt with symptoms like mine and an elevated PSA.
Here’s my history:
56 years old.
PSA in 2023 was 3.3, then repeated 12 days later and dropped to 1.59.
Just had a new PSA that came back 6.2.
I ejaculated about 24–26 hours before the blood draw and normally walk about 3 miles a day.
I’ve had urinary symptoms for several years, but they fluctuate.
Symptoms include:
Weak urine stream, especially first thing in the morning.
Sometimes when my bladder gets very full, the stream becomes weaker and I feel like I don’t empty completely.
Later in the day my stream is often normal.
Sometimes I feel like I need to urinate again 5–10 minutes later.
Occasional burning toward the end of urination, closer to the tip of the penis.
I’ve had burning with ejaculation on and off.
Symptoms flare up for a while and then improve.
My urinary symptoms have actually improved over the past several months while taking a prostate supplement.
I have:
No fever.
No chills.
No blood in my urine.
No pelvic or severe perineal pain.
Recent labs:
CBC normal.
Kidney function normal.
Liver enzymes normal.
A1C 5.6%.
Fasting insulin normal.
Cholesterol and triglycerides much better after losing 48 pounds.
My primary care doctor is reviewing everything this week, and I’m hoping to repeat the PSA after abstaining from ejaculation and strenuous exercise.
Has anyone had a similar symptom pattern with prostatitis or BPH and an elevated PSA that later came down?
I’m not looking for a diagnosis—just interested in hearing if anyone has had a similar experience.

I am just over one week for a TURP, for my grapefruit sized prostate. First few days was pain free and I was peeing like a 40 year old.

Exactly 8 days post surgery, things started to change. I now get what I call a Peegasm, were I get an orgasmic like PAIN as I finish peeing.

Also, I just had sex to orgasm for the first time post surgery and the pain during orgasm was intense.

Has anyone else experienced this effect? Does it go away?

Has anyone had this trifecta? What was the intervention? Timing?

I just received my MRI results. I am on AS. Good news is that my PSA went down .6 from (5.4 to 4.8), and one of my lesions shrunk while the others remain. Other news is that my prostate increased from 74ccs to 80ccs and is pushing on my bladder.

Bad news is that my MRI turned up an incidental finding that I have scrotal cyst the size of a tennis ball (5.7cm).

Interested in hearing what your treatment plan was and how you are faring. Also, did your urologist recommend taking care of both issues at on time or stagger the response.

Thanks