Postoperative Hematuria After Aquablation
Small blood clots in your urine one day after aquablation are expected and generally not concerning, as bleeding is a common early postoperative finding that typically resolves with continued catheter drainage and hydration.
Expected Postoperative Course
Hematuria with small clots is a normal part of recovery after aquablation, as the procedure involves waterjet resection of prostate tissue that creates raw surfaces requiring time to heal 1, 2.
The procedure requires electrocautery or catheter traction for hemostasis after tissue removal, and some degree of bleeding in the immediate postoperative period is anticipated 1.
Most bleeding complications occur within the first 48 hours and are managed conservatively with continuous bladder irrigation through the catheter 2, 3.
When Bleeding Becomes Concerning
You should contact your urologist if you experience:
Heavy bleeding with large clots that obstruct urine flow or cause inability to urinate 4.
Persistent bright red bleeding beyond 48-72 hours that doesn't improve with rest and hydration 2.
Symptoms of significant blood loss including dizziness, lightheadedness, rapid heart rate, or feeling faint 3.
Inability to pass urine due to clot obstruction, which may require bladder irrigation or clot evacuation 4.
Risk Factors for Significant Bleeding
Larger prostate volumes are associated with higher bleeding risk, with transfusion rates ranging from 0.8% in smaller prostates to 7.8% in very large glands when robust traction alone is used 3.
Overall transfusion rates with modern hemostatic techniques (selective bladder neck cautery with standard traction) are approximately 1.4-2.5% across all prostate sizes 3.
The average perioperative hemoglobin drop is 1.3 g/dL, with most patients experiencing mild blood loss that doesn't require intervention 4.
Management Approach
Continue adequate hydration to help flush small clots and maintain urine flow 2.
Avoid straining, heavy lifting, and vigorous activity for at least 2 weeks to prevent disrupting healing tissue 2.
Light pink or tea-colored urine is normal and may persist intermittently for several weeks 5.
Your catheter (if still in place) provides continuous drainage and helps prevent clot retention 3.
Common Pitfalls to Avoid
Don't panic at the sight of blood-tinged urine or small clots in the first week—this is expected 5.
Don't stop drinking fluids thinking it will reduce bleeding; adequate hydration actually helps by diluting urine and preventing clot formation 2.
Don't assume all bleeding is normal—contact your surgeon if bleeding worsens or you develop concerning symptoms 4.