Sure Buster. Yes it was uncomfortable, and as they say, the hospital is no place to get rest. It's VERY true!
Hello Buster and Blayneb,
I am speechless the kind of support u both are giving me. Now I have a better idea what to expect and how to prepare. My sincere thanks!
My holep will be on the afternoon of Nov 26. I requested afternoon but require me to report to the hospital at 10AM. If holep were in the morning, I would have to report to the hospital at 5AM.
Buster, re Q4, is seating on a soft cushion better? re Q5, what did u mean by weight limit?
Also Blayneb, walking means leak. What about standing in a train, is it OK.
I am speechless the kind of support u both are giving me. Now I have a better idea what to expect and how to prepare. My sincere thanks!
My holep will be on the afternoon of Nov 26. I requested afternoon but require me to report to the hospital at 10AM. If holep were in the morning, I would have to report to the hospital at 5AM.
Buster, re Q4, is seating on a soft cushion better? re Q5, what did u mean by weight limit?
Also Blayneb, walking means leak. What about standing in a train, is it OK.
Sure DL very glad to support you as much as possible. Know it is daunting prospect doing this.
What I can say is sitting is preferable for sure, you'll leak much less (if at all) sitting. Standing would be better than movement (walking) I'd think, but sitting is definitely preferable. I hope you can find a seat for the whole trip.
What I can say is sitting is preferable for sure, you'll leak much less (if at all) sitting. Standing would be better than movement (walking) I'd think, but sitting is definitely preferable. I hope you can find a seat for the whole trip.
Yes, I found it more comfortable. I can’t imagine sitting on a hard plastic chair.
You will be told that you can’t lift anything over a certain weight for several weeks. You should check with Dr. Das’ ffice for specifics.
FYI, when you are in surgery your legs are in stirrups and spread.
You will be told that you can’t lift anything over a certain weight for several weeks. You should check with Dr. Das’ ffice for specifics.
FYI, when you are in surgery your legs are in stirrups and spread.
Hello Buster and Blayneb,
Got it, thanks again!
Buster, what document?
Got it, thanks again!
Buster, what document?
I am getting a error when I try to pm you. I will keep trying.
The document is about kegels for HoLEP patients.
Regarding seating. I read on this group that sitting on a donut shaped pillow was most comfortable. I can’t say that my ride in a van was uncomfortable. Since I am not in an urban area I can’t say anything about trains.
One suggestion is to start doing kegels a month or more before your surgery.
The document is about kegels for HoLEP patients.
Regarding seating. I read on this group that sitting on a donut shaped pillow was most comfortable. I can’t say that my ride in a van was uncomfortable. Since I am not in an urban area I can’t say anything about trains.
One suggestion is to start doing kegels a month or more before your surgery.
Thank u and I look forward to reading the kegels document. Donut pillow is pillow with a hole in the middle? Not sure where I could buy such a pillow.
Just sent an email, not sure will receive a reply.
Title: Questions about HoLEP with ejaculation preservation
Dear Dr. Laniado,
A Patient who had HoLEP from you mentioned recently that you are now offering HoLEP with ejacualtion preservation. I am a BPH patient interested in this new technique and have some questions listed below.
1) What is the success rate that there is no retrograde ejaculation?
2) Is the ejaculation preservation similar to the one use in EP TURP or EP Green Light Laser?
3) I understand that in EP TURP or EP GLL the tissue about 1 cm in front of the verumontanum as well as those tissue at the level of the verumontanum are preserved. These tissues in regular HoLEP would have been enucleated. Is this correct? Is your ejaculation preservation technique similar?
4) Since in EP HoLEP, less tissue near the verumontanum are enucleated and as a result, the opening near the verumontanum is narrower than the regular HoLEP. Will the narrower opening degrades the functional outcomes and durability of the regular HoLEP? How much is the degradation?
5) Is there a trade off between functional outcomes vs the chance of having ejaculation preserved?
If you have time to answer my questions, I would greatly appreciated.
Sincerely,
Just sent an email, not sure will receive a reply.
Title: Questions about HoLEP with ejaculation preservation
Dear Dr. Laniado,
A Patient who had HoLEP from you mentioned recently that you are now offering HoLEP with ejacualtion preservation. I am a BPH patient interested in this new technique and have some questions listed below.
1) What is the success rate that there is no retrograde ejaculation?
2) Is the ejaculation preservation similar to the one use in EP TURP or EP Green Light Laser?
3) I understand that in EP TURP or EP GLL the tissue about 1 cm in front of the verumontanum as well as those tissue at the level of the verumontanum are preserved. These tissues in regular HoLEP would have been enucleated. Is this correct? Is your ejaculation preservation technique similar?
4) Since in EP HoLEP, less tissue near the verumontanum are enucleated and as a result, the opening near the verumontanum is narrower than the regular HoLEP. Will the narrower opening degrades the functional outcomes and durability of the regular HoLEP? How much is the degradation?
5) Is there a trade off between functional outcomes vs the chance of having ejaculation preserved?
If you have time to answer my questions, I would greatly appreciated.
Sincerely,
Hello Buster,
Ur idea of incorporating ejaculation into holep is a realistic one and is absolutely doable. I previously had post a Chinese urologist had performed EP Holep on a group of men with similar results as EP TURP.
I had done months of research on this topic. I am pretty certain that Laniado and the Chinese surgeon both used the EP TURP technique which was developed years ago as there is no other possible way.
I am also certain the the geometry near the verumontanum suggests that the uncut or preserved tissue required by preserving ejaculation will form a narrower diameter opening than the opening if these tissue were removed. A narrower opening will slow down urine flow. But now much is what I don’t know.
Definitely, there is a price to be paid for having ejaculation preserved.
I have the impression that urologists are strange professionals. They are very conservative. They are not eager to deploy new techniques neither will they let their patients know they have options and they can make trade off.
For example, Dr. Das and Miller use the bladderneck preservation technique to reduce incontinence from 17% to less than 2%, but other surgeons don’t offer this choice to their patients. And there is this low power no touc en bloc holep technique seemingly has better results, but no US urologist is talking about it. I found this incomprehensible.
Ur idea of incorporating ejaculation into holep is a realistic one and is absolutely doable. I previously had post a Chinese urologist had performed EP Holep on a group of men with similar results as EP TURP.
I had done months of research on this topic. I am pretty certain that Laniado and the Chinese surgeon both used the EP TURP technique which was developed years ago as there is no other possible way.
I am also certain the the geometry near the verumontanum suggests that the uncut or preserved tissue required by preserving ejaculation will form a narrower diameter opening than the opening if these tissue were removed. A narrower opening will slow down urine flow. But now much is what I don’t know.
Definitely, there is a price to be paid for having ejaculation preserved.
I have the impression that urologists are strange professionals. They are very conservative. They are not eager to deploy new techniques neither will they let their patients know they have options and they can make trade off.
For example, Dr. Das and Miller use the bladderneck preservation technique to reduce incontinence from 17% to less than 2%, but other surgeons don’t offer this choice to their patients. And there is this low power no touc en bloc holep technique seemingly has better results, but no US urologist is talking about it. I found this incomprehensible.
Kegels exercise.
I watched the utube u sent me. For the first time, I know how to do it. So there are two groups, the first one is 1 sec hold then off and repeat 45 times; follow by the second group of 10 sec hold then off, but video didn’t say how many times.
The video warned not to over do. Blayneb previously said that he practiced it four times a day.
Perhaps, I just follow his routine;
I watched the utube u sent me. For the first time, I know how to do it. So there are two groups, the first one is 1 sec hold then off and repeat 45 times; follow by the second group of 10 sec hold then off, but video didn’t say how many times.
The video warned not to over do. Blayneb previously said that he practiced it four times a day.
Perhaps, I just follow his routine;
DL, you may not experience the same level of sitting discomfort that Buster did. I had some in the perineal region, but it didn't really interfere with me sitting for long periods, so this may or may not be an issue for you, but it probably makes sense to try and find a pillow to sit on just in case.
I didn’t have problems sitting on the way home. One other member of this community had to travel a great distance. He reported that he would like to have a pillow with a hole in the center. I think they are commonly used after hemeroid surgery.
PELVIC FLOOR EXERCISES
Pelvic floor muscles can be strengthened through an exercise commonly referred to as the Kegels. Many men find that routinely performing their pelvic floor exercises reduces incontinence. Improving the function of the pelvic floor may also improve sexual function. To perform your Kegel exercises use one of the following cues...
I. While you are urinating attempt to stop your stream by squeezing your pelvic floor muscles.
II. When sitting in a chair squeeze your muscles to lift your scrotum in toward your belly button and lift it off the chair.
III. Squeeze your pelvic floor muscles as if you are trying to stop from passing gas.
Once you have learned how to tighten the muscles, you are ready to start doing pelvic floor exercises.
To start lay on your back with your legs supported and relaxed. Squeeze and relax the muscles of your pelvic floor. Once you are comfortable performing the exercises lying down, you are ready to start doing them in sitting or standing up.
While performing the exercises it is important to remember.
I. Do not hold your breath
II. Try to minimize squeezing the muscles of your buttocks, thighs and abdomen
III. Relax completely in between contractions
IV. The quality of your exercises is more important than the number you perform! Try to think about these muscles as your are moving them
The rule of 5's
Perform a set of 5 kegels, 5 times per day. Hold each contraction for 5 seconds.
Remember that every patient is unique. It could take time for you to see a difference in your continence. Just like you would not start training for a marathon the week of the race, it is important to begin your kegel exercises now to strengthen your pelvic floor properly in order to regain control of your urinary function.
Pelvic floor muscles can be strengthened through an exercise commonly referred to as the Kegels. Many men find that routinely performing their pelvic floor exercises reduces incontinence. Improving the function of the pelvic floor may also improve sexual function. To perform your Kegel exercises use one of the following cues...
I. While you are urinating attempt to stop your stream by squeezing your pelvic floor muscles.
II. When sitting in a chair squeeze your muscles to lift your scrotum in toward your belly button and lift it off the chair.
III. Squeeze your pelvic floor muscles as if you are trying to stop from passing gas.
Once you have learned how to tighten the muscles, you are ready to start doing pelvic floor exercises.
To start lay on your back with your legs supported and relaxed. Squeeze and relax the muscles of your pelvic floor. Once you are comfortable performing the exercises lying down, you are ready to start doing them in sitting or standing up.
While performing the exercises it is important to remember.
I. Do not hold your breath
II. Try to minimize squeezing the muscles of your buttocks, thighs and abdomen
III. Relax completely in between contractions
IV. The quality of your exercises is more important than the number you perform! Try to think about these muscles as your are moving them
The rule of 5's
Perform a set of 5 kegels, 5 times per day. Hold each contraction for 5 seconds.
Remember that every patient is unique. It could take time for you to see a difference in your continence. Just like you would not start training for a marathon the week of the race, it is important to begin your kegel exercises now to strengthen your pelvic floor properly in order to regain control of your urinary function.
Some other thoughts on Kegels.
Break them up doing some throughout the day.
Take a day off periodically so your muscles can recover.
Another variation is to lay on your back, lift your hips and do 5 five or more quick contractions.
Don’t forget you need to avoid food that irritates your bladder.
Break them up doing some throughout the day.
Take a day off periodically so your muscles can recover.
Another variation is to lay on your back, lift your hips and do 5 five or more quick contractions.
Don’t forget you need to avoid food that irritates your bladder.
Sorry if I misrepresented Buster. Just worried that if DL tries to stand for the duration of a long train ride so soon after surgery he's going to leak a lot. I walked from Dr Das's office to the hotel immediately after catheter removal and I flowed uncontrollably like a river. It wasn't until I got to the hotel and was able to sit or lay for an extended period that things got under control somewhat. Hopefully, since his surgery will be possibly less extensive than mine due to smaller prostate size, he won't have my issues.
No problem. I completely understand about long periods of standing especially on the day after surgery.
I wet my pants 3 times the day after surgery. I finally had to double layer and did that for some time.
I wet my pants 3 times the day after surgery. I finally had to double layer and did that for some time.