Please keep us posted!
I am at a point where my flow is not restricted in anyway and my incontinence is a thing of the past.
Thanks DL, I figured out that my flow was slower when less full. When I have 150cc or more which is the min for a flow test, I am getting 15.5 to 19.5 cc/sec.(last result) (average flow, not peak but it seems pretty steady anyway from start to finish) . Havent checked in a few days, but I will again. Seems same as before. Linear increase is good to know. After reading your experience it's easy to be paranoid about a stricture! Also, your info about how fast an infection can move is very helpful and may actually save someone someday. I'm just over a month now. Fingers crossed. Oh, IIRC means "If I Recall Correctly". Looking forward to reading about your full recovery finally!
NS
Once again, thanks for ur well wishes! I appreciate it
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Buster,
Congrats, this is the desired outcome from HoLEP! Happy to see u finally rip of incontinence and hopeful, Blayneb will follow ur foot step.
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Ralph,
If u have a steady urine stream, I agree that a measurement cup and a stop watch Will give a good estimate of Qmax.
19.5cc/s for Qaverage is a great number one month post HoLEP. I think that ur progress is normal.
This forum has been very helpful to me in the process of planning and getting through a HoLEP procedure, so I thought I would contribute my recent experience. I threw in some of the logistics of travel since there have been discussions about it here before.
I am 63 y.o. living in central PA and have had BPH symptoms for 10 years. My Prostate Symptom Score was in the 22-25 range during the latest few years. I took Flomax for most of 2018 but quit due to its effect on the irises of my eyes. I am a candidate for future cataract surgery and Flomax can greatly complicate that. Actually the damage may already be done and irreversible. In addition, Flomax caused constant nasal congestion.
My research into surgical solutions fairly quickly led to the conclusion that HoLEP was promising, but that it requires a surgeon with considerable training and experience. As many of you have found, there aren't a lot of those around. I wasn't thrilled about flying to Indianapolis, Mayo, Arizona, or anywhere else. A little more digging in this forum turned up Dr. Akhil Das at Jefferson Univ. Hospital in Philadephia who, as it turns out, seems to have as much experience as anyone, having trained in New Zealand and completed over 2000 HoLEP's. It's a 2.5 hour drive to Philadephia for me and Jefferson is in my Blue Cross network. No pre-authorization was required. I didn’t bother talking to my family doc about it since he had never heard of HoLEP and could only recommend green light laser.
I met with Dr. Das in December without having had any urological testing done prior other than the bladder retention ultrasound done just before walking into his office. He was friendly and attentive and answered my questions thoughtfully. Actually I had relatively few questions due to my previous research in this forum and elsewhere. We both concluded I was a good candidate and he scheduled the procedure himself, right then and there. I asked him how I could handle pre-op testing given my distance from Philly and the fact that I have no local urologist. He sent me down the hall with a nurse who quickly set me up for a trans-rectal ultrasound, and then he came in and performed it himself! I probably caught him with a rare gap in his schedule, so I wouldn't count on treatment like that routinely from any surgeon, but I was very grateful for avoiding an extra trip to the city. From then until surgery, all I needed was some bloodwork and urinalysis done locally.
My prostate was 66 grams, so it goes to show that you don't need a huge prostate to have serious symptoms.
On the day before surgery, my wife and I took the train to Philly even though the closest station is 45 minutes away near Harrisburg. By car, my wife would have a bad time driving me back out of the city if I wasn't up to it. Jefferson has an arrangement with the Holiday Inn Express for much reduced rates. It was very nice and only 2 1/2 blocks from the hospital. My wife felt safe walking alone while I was in the hospital and there are some great restaurants within a few blocks.
I reported the next morning at 9:45. The nurses in pre-op were very efficient and attentive. After an IV hookup, the anesthesiologist visited and explained things thoroughly (general anesthesia), as did Dr. Das to ask if I had any questions or concerns. As I was being wheeled into the OR, something was injected into the IV line. "Here comes the happy juice!" was the last thing I remember hearing. Apparently the procedure lasted something over an hour-- a bit longer than Dr. Das expected. Apparently I had an unusually shaped median lobe.
I awoke in post-op in quite a bit of pain seeming to originate from my bladder. The attending nurse was right there and dosed me a couple of times with IV fentanyl. The pain subsided to a tolerable level within minutes. I could tell that the catheter was there but it was not a source of serious pain. Later, I was wheeled to a private room. The pain did not ramp back up after the fentanyl wore off. I wasn't exactly comfortable but did not need further pain relief. The nurses in the ward were friendly and extremely attentive. The outflow from the bladder flushing through the catheter had to be emptied every hour, or so it seemed.
There was some discussion in this forum about bringing Ambien to help with sleep. I did bring some, but was surprised when the nurse showed up at 9:30 pm with a dose of it. With the Ambien, a private room with the door shut, and some earplugs I managed to get about 6 hours of sleep that night. However, it was interrupted by a bout of fairly intense bladder pain. The nurse arrived with 1 minute of hitting the call button. She consulted with the urologist-on-call and was back within 20 minutes with medication to quiet a bladder spasm. It worked and the spasm did not re-occur after that.
In the morning, the bladder irrigation was shut off and the catheter removed. I can’t say that it was a thoroughly enjoyable process but it wasn't as bad as I anticipated. Of course, after that I was required to urinate twice followed by bladder ultrasound each time to determine the residual, which was 15 mL the first time and zero mL the second. My first trip to the bathroom was anxiety provoking, anticipating that sudden urine flow through a raw and angry tract would send me to the moon. It definitely got my full and upright attention but it was not unbearable. But holy fire hose, it was all over in 9 seconds. It used to take me over twice that long just to get a weak flow started.
After discharge instructions and scrips for an antibiotic and multiple laxatives, I was out of there by 11 am and back to the hotel to check out. Unfortunately, I was still processing all that water that I drank and just barely made it those 2 ½ blocks without a gusher. As others here have mentioned, the hospital does not have male-specific pads or incontinence underwear, only female pads and flimsy disposable briefs to tuck them into. Bring your own Depends type underwear. If you find that leakage is a minor problem, switch to some fairly snug fitting briefs along with male shields. They will not work very well in loose boxers. CVS Men’s Shields were perfect for me.
A 10-minute Uber ride back to the 30th Street Amtrak station and we were on our way home. There has been some discussion here in the past about train vs. car. I have to say that taking the train was a really good decision. It was smooth, comfortable and relaxing, and I was 5 steps away from a reasonably clean and spacious bathroom. It would have been worth it just to avoid driving the Schuylkill Expressway.
Home now for 4 days. The burning during urination is mostly gone, though there is a little blood every time. Dr. Das assures me that it’s normal and may last 4 weeks or more. There is no other pain. I only occasionally leak a few drops if I laugh hard while forgetting to clench. It is way less of a nuisance than the post-void dribbling I had prior to surgery. I am still wearing shields only because of blood spotting.
I did a crude flow rate check with a graduated cylinder and a stopwatch and came up with an average of 22.5 mL/sec. That beats the published average flow rate for males aged 14-45. Of course I have no way of determining Qmax, but Dr. Das suggested that my number probably translates to a Qmax of 30 mL/sec.
Dr. Das agreed to a video conference as a follow-up provided I wasn’t having any significant issues. You need to be registered on the Jefferson “MyChart” website to do this, but it saved me a hell of a lot of time and driving. It took a little fiddling to set up the conference on my laptop because it only works with Internet Explorer which I had disabled. It’s probably easier to do on a smartphone with the appropriate app. Dr. Das seemed to be using his phone.
Now, if you have read more than a few pages of comments on this forum, you already realize that my case was probably as good as it gets, though it’s a bit early to claim that I’m in the clear (for instance, changes in sexual sensation). I’m relatively young at 63, am in very good health, and did not have a particularly large prostate. I know that several of you have struggled with long-term incontinence, strictures, infections etc, but I haven’t noticed very many that regret having had the procedure.
To reiterate, my experience with Dr. Das and the Jefferson staff was first rate from start to finish and I can’t recommend them highly enough.
I’m glad to hear that you had such a supportive surgery team. That makes all the difference. I hope your recovery goes well.
Hello Mariner,
Thanks for the detailed report on your Holep. It really sounds like it went as well as one could hope. I have never met Dr. Das. My Holep was in Indianapolis with Dr. Lingeman and he was fine, but did not extend himself the way Dr. Das did for you, nor would I have expected him to. Yours sounds like a unique experience.
As I have previously explained on this site, it took me a year before I was completely incontinence free.
Perhaps because I was 79 two years ago when I had the surgery? Anyway, I certainly don't regret having the Holep. It worked for me. I go to the gym three times a week and don't worry about leakage.
Congratulations on your successful experience.
hey all, couple mos after holep, got my uroflow numbers and it's 25ml/sec qmax, 10ml/sec qavg with a nice bell curve. Dr is pleased. Just wondering what others getting?
I got the bill from RWJ hospital for my 9 days hospital stay, and it is about $200K. This is just for the hospital stay and there are other charges. It costs more than $20K per day as expensive as the Stanford University hospital. When one faces the problem of life and death , shall the family sell everything to save ur life and leave nothing for the family to live on? A difficult decision in life. What price does life worth?
I checked in through the Emergency. What would have happened If I did not have insurance or didn’t have money to pay for the treatment? Would I be turned away and let die or the cost would be paid by the tax payers?
It costs about $1K per hr to stay in the hospital!.
There is a grey area. What if the patient has no insurance but does have some asset. For example, a house and a car to go to work. He can pay part of the hospital cost by selling everything he has. What will happen in the scenario?
The system is clearly broken. And it's not just the uninsured driving prices up. We also have the insurance companies and the large hospital corporations that are obligated to provide returns for their shareholders. All that is on top of the high costs for all staff, equipment, products, and services required by the hospital.
Single payer certainly has downsides, but I've talked to enough Canadians who wouldn't trade their plan for ours.