In a male patient over 60 years old undergoing Aquablation for benign prostatic hyperplasia while on tamsulosin and possibly tadalafil, when does postoperative inflammation reach its peak severity?

Peak Inflammation After Aquablation

Postoperative inflammation following Aquablation typically peaks within the first 24-48 hours after surgery, with the most severe symptoms—including bladder spasms, dysuria, and hematuria—occurring during this immediate postoperative window. 1

Timeline of Inflammatory Response

Immediate Postoperative Period (Day 0-1)

• The first 24 hours represent the most critical period for inflammation-related complications, with patients experiencing peak bladder spasms, pain, and hematuria during catheter indwelling 1
• Multimodal analgesia with acetaminophen and NSAIDs should be initiated immediately to manage inflammatory pain, avoiding opioids when possible due to constipation risk that can exacerbate prostatic bleeding 1
• Anticholinergic agents may be used cautiously for bladder spasm relief during this peak inflammatory period, though they carry urinary retention risk 1

Early Recovery Phase (Days 1-3)

• Catheter removal on postoperative day 1 is recommended in uncomplicated cases to reduce infection risk and patient discomfort, though inflammation remains significant during this period 1
• Bleeding complications requiring intervention occur most commonly in the first 3 days postoperatively, with hemorrhage rates of 1.4% using systematic cautery techniques 2
• Hospital readmission rates are highest within the first week, often related to ongoing inflammatory complications such as clot retention or urinary retention 3

Subacute Phase (Days 3-14)

• Inflammation gradually subsides over the first 1-2 weeks, with most patients able to resume mild to moderate physical activity without symptoms by this timeframe 4
• Clavien-Dindo grade 2 complications occur in approximately 26% of patients within the first 3 months, significantly lower than TURP (42%), with most complications manifesting in the first 2 weeks 5

Clinical Implications for Management

Pain Control Strategy

• Apply local measures such as cool packs to the perineum and topical anesthetic sprays for additional relief during the peak inflammatory period 1
• Severe pain unresponsive to oral medications warrants immediate evaluation for bladder spasm, clot retention, or other complications 1

Monitoring for Complications

• Heavy bleeding with clots or inability to void after catheter removal may necessitate catheter reinsertion or bladder irrigation, particularly during the first 48-72 hours when inflammation is most severe 1
• Fever >38.5°C should prompt evaluation for urinary tract infection, as indwelling catheters markedly increase infection risk during the inflammatory period 1

Activity Restrictions

• Early mobilization should be encouraged once hemodynamically stable to lower atelectasis and thromboembolism risk, but strenuous activity should be avoided during the first 1-2 weeks when inflammation peaks 1
• Bowel management with stool softeners should be initiated immediately, as constipation raises intra-abdominal pressure and bleeding risk during the inflammatory phase 1

Evidence Quality Considerations

The guideline evidence 1 provides the most direct recommendations for managing the inflammatory period, though it draws from general postoperative principles rather than Aquablation-specific data. Research evidence 2, 3 confirms that most complications occur within the first week, supporting the clinical timeline described. The 30-day readmission data 3 suggests that while peak inflammation occurs early, inflammatory complications can manifest throughout the first month, particularly in patients with larger prostates or during the procedural learning curve.