Barry, again you are to be commended for your thoroughness in detailing your HoLEP experience. I am having one performed next Monday at Vanderblit by Dr. Nicole Miller. In my research she came out on top, even ahead of her mentor Dr. Lingeman. I must say though I would not be a happy camper if I was still having discomfort after six weeks and even more so if I was peeing every one to two hours. As it is now, I don't pee that much at night. But maybe this is par for the course and the road to recovery. I have always believed some of the testimonials for some of the HoLEP doctors were sugar coated and in some respects sponsored by the doctors themselves. Yours is one of the few that tells it like it is. Many thanks for that.
46goat, Some retired people are forced into Medicare Advantage because it costs less and it is all they can afford on a limited and mostly fixed retirement income. It is a very sad commentary about the United States, one of the richest countries in the world, that the level of medical care one gets is a function of what one can afford. I always had a good corporate plan for myself and my wife and now that I retired I have Medicare and a full supplemental plan + prescription and dental plans. It is only luck that I am able to do this because I stumbled (by virtue of the family I was born into) into being able to get an outstanding education and then by blind luck ended up in an industry that provided me with reliable good paying employment for my entire 40+ year career. All too many people do not have this fortune and it is terribly sad they do not have access to whatever medical care they want on demand solely because our society and government just does not think it is important. So, I do not think it is so easy to just get rid of Medicare Advantage and then go with something that is more expensive.
hiyield, good luck next week.
I think you will find my post surgical symptoms are typical and to be expected. I suspect yours will be similar.
My pre-surgical expectations were unrealistic because they were based on a previous surgical experience that really was not comparable. Ten years ago I had a three level cervical fusion and it was essentially a non-event with no post surgical issues except for wearing a mega-collar for six weeks and a wonderful wife that was on my butt if I turned my eyeballs too far. I incorrectly assumed the post surgical experience for HoLEP would be the same. Two different procedures with very different post surgical experiences.
I am in Australia, so systems are a bit different, but your comments are very comforting to would be HOLEP patients and I would endorse everything you say to my present stage: 10 days post op. I have no signs of problems, other than bleeding as expected, but my speciallist says I should not work or drive for 4-6 weeks. I cannot find online support for this. (And I ahve been naughty ... I HAVE to walk, albeit I am very slow and careful about it. But I want to get back to work. Those worried about the procedure, all I can add is that this seems like one hell of an amazing procedure. I had put up with serious, dreadfully unpleasant, urinary retention. I had emergency catherters draining up to two litres (no joke) on three occasions before waking up to acepting that surgery was absolutely necessary. But now I wonder why I can't go back to work!
Any more comments would be appreciated. And all the best to HoLEP patients!
Since I quit running (now walk five miles instead) and went on Uroxatral and Avodart, my bladder is down to around the 850 to 900cc level. Still too high, so that along with my enlarged prostate (70 grams) is why I have to bite the bullet and get the HoLEP. Here in the States the doctors say we can be back to normal activities in one to two weeks. We shall see.
Unfortunately, and I had been warned of this by both Dr. Miler and my local urologist, the prostate turned out to not be my urinary/retention problem. Instead, my problem is my bladder. In hindsight my bladder has been my problem for almost 10 years. Most likely this is due to damage in my back at L4 which controls the bladder detusor and perineal floor. Years and years of hard running I guess have taken its toll. On the plus side, as bad as my back is, so far I have encountered no back pain, much to the amazement of my doctors. Anyway, on to my next adventure in solving my retention problems.
Dear hiyield,
did you have surgery with Dr. Lingeman?
If so were you satisfied?
fiddler, no, see my post above about Dr. Nicole Miller. I chose not to have Dr. Lingeman do my HoLEP. Just from my research and actually speaking with some HoLEP patients, the only two doctors I would consider for a HoLEP would be Dr. Nicole Miller and Dr. Lingeman.
I would strongly encourage everyone to also seriously consider Dr Amy Krambek at the Mayo Clinic in Rochester. She performed a HoLEP procedure on me last September and I was more than very pleased with both her and the Mayo Clinic.
Late last spring when I selected the facility/surgeon I considered both Dr Lingeman and Dr. Krambek. I did not consider Vanderbilt but had no specific reason for not doing so.
I saw nothing negative posted about Dr Lingeman, and, in fact, heard much positive, but I was nevertheless concerned about using him for two reasons. First, he appears to have some very significant financial ties with Lumis, the manufacturer of the HoLEP laser equipment. This concerned me because I felt this might cause him to be less conservative than I desired if it came down to a marginal decision if HoLEP was the optimum procedure for me. Second, the Mayo required a two day evaluation before they would even schedule the procedure. This two day evaluation required a 1600 mile trip to Rochester, was very thorough, and included an ultra sound study and a catheterization (performed by Dr. Krambek). Per a telephone call with Dr. Lingeman's office, Dr. Lingeman required only a single visit that included meeting with him in the morning and the procedure in the afternoon. The Mayo approach, although certainly much less convenient for someone living 1600 miles from Rochester, strongly appealed to me because it is obviously much more conservative. The one day day slam bam thank you Maam approach (in my opinion) just reinforced my concerns about potentially being too quick on the trigger.
I cannot say enough positive about the Mayo Clinic with respect to the magnificent facilities, the competence of everyone we encountered, and the outstanding care I received from everyone (please see another post where I discussed this in detail). Additionally, everyone we met could not have been any nicer, respectful, or accommodating.
I do want to comment on one minor incident that does not reflect on the quality of care at the Mayo but is more a commentary that, even at the Mayo, you deal with physicians that have inflated egos and these egos can go a long way to create disrespect and adverse feelings. Dr. Krambek has a physician, Dr, Charchenko, that works with her. I believe he is her fellow. About a month after the procedure I received a formal write up signed by him summarizing my case. In it he listed my medical history including current and past diagnoses. To my surprise he included COPD and Hypolipidemia, neither one a condition that even remotely effects me. I spoke with him by telephone to correct these errors. Instead of simply acknowledging an error and correcting it (my expectation), he strongly argued and defended the reasons why he included these diagnoses. He listed COPD simply because I smoked for 15 years. I explained again I have not smoked for 37 years and have no symptoms, but he still needed to defend his diagnosis. He diagnosed Hypolipidemia, not on clinical or lab history, but simply because I take Lipitor. I explained again I never had high cholesterol but only take Lipitor for prophylactic reasons to counter an adverse genetic influence but he also found reasons to defend his diagnosis. In my opinion these diagnoses appeared as the result of a hasty and sloppy review of my record. I also would hate to have to use Charchenko as a physician because I do not think he is capable of being candid and open with his patients. It is not my desire to slam what I am sure is a technically very capable physician (he must be capable to be a fellow at the Mayo), but his excuses on the phone were disrespectful and indicative of someone incapable of being candid or admitting error. Obviously, his disrespect for me left me with a very sour taste in my mouth.
Since I am in a forum responding mode tonight it seems like an update to my experience may be worthwhile.
The procedure was done on 9/19 and today is 11/23.
For the overwhelming most part the bleeding has long stopped. A few days ago I saw a small slug of blood at the beginning of flow a few times but it quickly cleared. I have no idea what triggered this other than I restarted my 325 mg a day aspirin about a week ago.
Leakage is minimal. I was using very minimal pads but went away for four days earlier this week and forgot to take pads with me. There was no real problem without them and I will probably not use them anymore.
There is no internal discomfort at all at any time.
Flow is great and a couple of ultrasound checks over the past couple weeks indicates only very little residual (
Duration of flow, frequency, and discomfort during flow are not at all where I want them to be and these symptoms are not showing any real sign of trending in the right direction. In fact, I perceive these symptoms have even trended in the wrong direction over the past couple of weeks. Flow duration varies from only 3 to 8 seconds or so. There is a consequential burst of discomfort when flow starts and when flow stops, but no discomfort during steady state flow. Frequency is about every hour or less but sometimes consequentially longer if I am sitting still, driving, reading, sitting at the computer, etc. Sometimes I need to pee every hour or two during the night. When the need suddenly arises to pee it can get very intense and can even be painful (nothing I cannot easily deal with but it does get my full attention).
Suspecting an infection I saw a urologist at the local Cleveland Clinic. The Mayo, at 1600 miles away, is obviously too far. The urinalysis and culture came back negative. I tried Vesicare (bladder spasms) but it did not appear to be effective and made me light headed/sleepy. I am awaiting a second urinalysys/culture now but not expecting it to show anything. Nevertheless, been on Cipro (500 mg BID 7 days) since Tuesday (Friday night now) but I am not seeing any benefit (no surprise). It looks like these are just symptoms that take a long term to resolve. The Cleveland Clinic Urologist (very competent IMO) does not seem concerned, especially with a negative culture.
My wife told a friend I went from barely being able to pee to now peeing all the time. It does seem sometimes this is a good characterization of the experience so far.
If I had to do it all over again I would again chose HoLEP as it is still a much better solution than TURP, etc. I fully believe the issues I discussed above will eventually resolve and, realistically, they are more of a pain in the ass than any real issue to deal with.
In my opinion, there are some medical solutions in Phase III trials now that appear to have the potential of being a much more more elegant solution than the, by comparison, crude surgical techniques (including HoLEP) that is currently the best technology has to offer. This medical solutions include injection of botulism toxin (Botox) directly into the prostate. There is also a drug by Nymox Pharmaceuticals, also directly injected, that I understand has much promise. I was hoping to wait until one of these products became main stream but that did not happen prior to my need to do something became more critical. I ended up with a 150 cc prostate by waiting but have no regrets.
Hi Barry, How about an update? Completely healed by now?? Am contemplating same procedure. I'm lucky in that I live in Rochester and am quite familiar with "the Clinic" as we call it. I'm almost 70. How does that compare with your age? Just wondering.
Thanks for the very informative posts!
WkRaut, there are one or more updates since the post you responded to above. They may answer your questions.
A week ago I posted and reported about an annoying ongoing, but certainly easily manageable, problem with the frequency I need to pee and discomfort at the start and stop of flow. Just some updates on this.
Two cultures over the past two weeks proved negative so the medical profession is now just taking the approach that these symptoms are just part of the territory after one of these types of procedures and, with time, will resolve. I suspect this is probably indeed so but I also see this non-response from my urologist as a license for me to experiment, so I did.
I figured the two bursts of discomfort (often very significant) at the start and cessation of flow (not during steady state flow) could be dealt with via either an analgesic or an anti-inflammatory drug. One night I took a 5mg oxycodone prescribed at the time the procedure was done. Other than making me sleepy and feel real good, it did nothing consequential for the discomfort associated with peeing. This was probably good because as pleasant as oxycodone is to take it can only be used on a very limited basis for very obvious reasons. Also, I could only realistically take this drug at night because it knocks the c**p out of me (pleasant) but I am not at all willing to spend my day that way.
Since an industrial strength pain reliever was not consequentially effective, I assumed, an anti-inflammatory drug might be worth trying, making a working assumption the discomfort was the result of inflamed tissue. I then took a 600 mg Motrin (AKA Ibuprofen/Advil/etc.) left over from dental surgery a few years ago. To my pleasant surprise it proved very effective. It had marginal effect on reducing how often I needed to pee but it almost completely eliminated the two bursts of unpleasant discomfort every time I take a leak. I had five 600 mg tablets and used them up over a three day period and enjoyed three pain free days.
Ibuprofen is both an analgesic and an anti-inflammatory so I had no real method of knowing which of these two effects resulted in the relief from the discomfort. I could have stopped here and just taken Advil as needed but my curiosity prevailed. I assumed it was the anti-inflammatory effect as oxycodone, a very effective pain reliever, previously proved mostly ineffective. I waited a day after the last Ibuprofen and then started a six day tapering regimen of prednisolone (a corticosteroid and very effective anti-inflammatory) that was previously prescribed for me but never used. It has had absolutely no effect on my symptoms.
I then tried Tylenol (acetaminophen), a common analgesic with no real anti-inflammatory characteristic that I am aware of. It proved very effective. Tylenol can easily cause major liver problems if taken continuously so I am not willing to use Tylenol except very infrequently and then in very limited doses.
I went back to Advil (a much safer drug in my opinion) but now found three 200 mg tablets (equivalent to a single 600 mg Motrin tablet) help but are not not as dramatically effective as the Motrin was when I first started experimenting.
Two findings I cannot explain. First, I cannot explain why taking Advil now has reduced efficacy compared to when I tried it last week. Maybe this is because I am still taking the prednisolone as it is essential to finish the full prescription with the tapering dose. I have two days left. Second, it seems very obvious to me now, the bursts of discomfort at the beginning and end of flow is not the result of tissue inflammation since the prednisolone was so completely ineffective. Therefore, I cannot explain why Tylenol and Advil proved very effective but oxycodone, a much more effective pain reliever, did not. I understand Tylenol/Advil work in a manner different from an opioid like oxycodone and this might explain what I observed but this is now well beyond my level of knowledge so I am now returning to my day job.
Hi Barry,
Thanks for the swift response and info. I hope your problems continue to abate, and that you will keep updatng us. Thanks again!
In a few weeks will begin a new thread on my experience with Dr. Nicole Miller at Vanderbilt. A most positive experience I should add with no pain whatsoever and only about two to three days of blood in the urine after my HoLEP. I am five weeks out and shocked that I am completely emptying my bladder now. That's the first time in over 8 years plus. I am shocked because Dr. Miller, a host of other doctors, as well as myself were doubtful I could ever get my bladder back to 30 to 50 cc (empty) because it had become so massively distended over the years. I did do some self cathing at Dr. Miller's request for a few weeks after the surgery but fortunately that is now past history. I still don't know how much of my past problems were due to my prostate, my stones, or the nerves in my back. As a precaution I am taking bethanechol and uroxatral to both stimulate and relax the bladder. As for the nerves in my back, I purchased an inversion table and one of those temperpedic type foam beds. I am sleeping better than I have since the 1990s.