Experiences with Holmium Laser Enucleation of the Prostate, HoLEP, Laser Surgery

First post. What a helpful forum. I just had Holep 4 days ago on July 27, 2015. Used Dr. Kuo at St. Peters Hospital in Albany, NY. Dr. Kuo learned under Dr. Lingeman. He is an energetic young man (under 50, I believe). My prostate has been closed for years but I did not have to cath due to taking 20mg a day of terazonsin. It relaxes the muscles and lets you pee, albeit, slowing and often. But it kept me going for years. Dr. Kuo said he was surprised I could pee at all since the prostate was totally closing my urethra, but the drug was magic for me.

Surgery was 3.5 hours and almost 2 hours in recovery. By that evening the nausea stopped and I felt pretty good. The next morning the catheter was removed which was extremely painful for me. Cistoscope was also very painful, so I think that's just me. Some men don't seem to be as sensitive to that as I am. I got released from the hospital that afternoon and drove 2 hours home after my wife retrieved the car from the parking lot. Walking was a bit uncomfortable, but driving was no problem.

So now a few days later, peeing goes fast and with plenty of control. It is painful every time though. I guess that could take weeks for everything to heal. But I've been sleeping about 6 hours at night without having to get up. Used to be 1 to 2 hours before surgery.

I have a 1 month followup appointment with Dr. Kuo. From the first night after surgery, erections came back. So no problem there. Hope I will never have to go through this again. It has been painful for me, but I think others may not feel the sensitivity that I am feeling. Feel free to send me questions.

11 days post surgery:
By Day 7, the worst pains started to subside, the stabbing pains while urinating. Now I have a mild pain in the peranium and a pain in the penis tip. But it's totally livable for less than two weeks from surgery and considering how bad the first week was. My stream is strong and I'm down to 1 wake up at night. I started having erections from the first day I was home. I was surprised they were back immediately. I gotta say, I wish they hadn't returned so fast cause they are a bit painful and I can't do anything about it anyway for awhile. But I'm glad to see all the functions are working. I'm having some leakage issues so continue to use pads. Hopefully, I'll see improvement in that area next.

Hi All! For some reason I stopped getting alertsw of posts and just realized it this week. I just read over the last month or so of posts and it seems all is going well for others. No urinary issues at all for me now almost three years since surgery in Philly with Dr. Das. I think next checkup is in December. (Having other issues at age 70 - mostly depression and anxiety ones) but, otherwise life is good and I may get up ONCE a night if I have a hot beverage after dinner or a BIG salad (mostly water in that of course). I'm here to answer any questions I can, especially about Dr. Das at Jefferson here in Philly.

Hi All,

A quick follow-up since I had griped here earlier about my reservations to having this procedure done. Recovery kicked my butt, I cannot lie. I experienced a lot of "residual spasms" of the bladder, which made for VERY painful urination. My urologist says this occurs in about

Same experiences I had with mine. FYI: ten weeks was the "magic" number for my recovery, healthy middle-50's active adult. I had a lot of "residual" bladder spasms which made urinating horribly painful. My urologists said about 20% experienced this. But, at the 10 week mark the pain turned off, like the flip of a switch. Since then, life is great. Sleep thru the night, and pee like a 5yr old.

For some reason, it appears my post was cut off mid-sentence. Reposting:

I had griped here that I had reservations about this procedure. Post-op was very painful, and I experienced very painful urination out to 10 weeks. Doctor said it was "residual" bladder spasms, which occur in about 20% of her patients. I was not a happy camper. However, at 10 weeks, it was like flipping a switch. Pain was gone, and life is great! I sleep entirely through the night without waking up, and most importantly, I HAVE ENERGY again. It's amazing. My doctor tried to get me to do this procedure years back. I regret not heeding her advice. I am no longer enviable of my 4yr old grandson, who loves to pee outside. I can't wait to write my name in the snow this winter! I highly recommend Dr. Nicole Miller at Vanderbilt Hospital in Nashville, TN. She has been my urologist for years and I love her. Great bedside manner, very funny, and a great doctor. If you are contemplating HOLEP, quit thinking and start doing. You won't regret it. Post-op is tough, but the payoff, in my experience, is tremendous.

Thanks Trevor. Some of us had a easier time post-op but nearly everyone made it to the 10 week mark and was fully cured. My 10 week issue wasn't pain but frequent urges and wearing a pad took care of that. I'm not it's not 100 perfect but for a one night non-evasiove surgery it's really important for guy to consider. Remember this is rarely advertised and in Philly Jefferson does not promote the procedure by Dr. Das (He is ONLY one qualified in Philly or New Jersey (to my knowledge). Glad you are healed. REport back when it snows so we can hear what you "wrote"

Thanks for the reply. I'm in my 3rd week, the pains move around and come and go and the leakage is mostly there. I'll look forward to week 10 or so.

I tried to write my name in the snow but it came out to fast! I only got three letters and ran out of Pee!!! That is a GOOD thing!!! Steve will remember I had to pee out of a deer stand . I tried for distance . It was close to 12 feet! No more dribbling on my boots!!! just me

22 days out and I've stopped wearing leakage protection at home. I guess I'll still put something on if I'm going out for a few hours, just in case.

I had the HoLep Surgery on Aug 24, 2015.  It was done by Dr. Lingeman at Methodist Hospital in Indianapolis.

On the day of the procedures my wife and I met with Dr. Lingeman in his office for about 20 minutes.  He answered any last minute questions and gave some details as to what to expect.  He is a great guy and someone you feel you can trust.  There is no way you could get anyone more qualified than Dr. Lingeman.  

My surgery was his 5th of the day and the last one.  After the office visit with Dr. Lingeman his nurse Stephanie (also a great person) walked us down to admitting where we went through paperwork and then I was brought up to pre-op.  Around 4:30 Dr. Lingeman came in and told us they were cleaning up the room and would come for me in about a half hour.  The anesthesiologist came in a short time later and talked to me, injected something and then I remember being wheeled in to surgery and my next recollection is waking in the recovery room.

I was definitely in A LOT OF PAIN all focused on the end of my penis.  The pain medication was barely putting a dent in the pain.  An hour or so later I was taken to a private room and the pain became somewhat less; but still pretty intense.  The nurses there were also really good for taking care of your needs, being really pleasant and helpful.

About 4 AM (about 11 hours after surgery) the nurse removed the catheter.  I did not find that as painful as some others on this blog have described.  The worst part of that was removing the tape on my leg that had been used to secure the catheter.  (Would it really be a big deal to expect them to shave a small portion of my upper leg before putting their version of duct tape on my leg?)

After the catheter was removed I was told that after I urinated twice (into a portable urinal so they can measure it) I could go home (a hotel).  The urinating came within an hour of the catheter removal.  It was very painful, especially at the tip, and I was not prepared for how red it was.  Seemed like straight blood to me.

In any event, I was released a few hours later.

Dr. Lingeman removed 75 grams of my (formerly) 91 gram prostate which I found out yesterday was negative for cancer (thank God!).

I am now 6 days post op and, other than issues peeing and leakage I feel great.  Every time I pee it is accompanied by a lot of pain and blood and I am experiencing some "leakage", though not a lot.   However, all three (pain, blood and leakage) have diminished greatly over the previous few days.  

Something I find a bit odd is that until yesterday all the pain while peeing was focused at the front of my penis and would be there the entire time I peed and a while afterward.  However, in the last couple of days that pain has almost gone away; and has been replaced by a different type of pain.  When I am about one half through peeing I am now getting a different type of pain further back in my penis.  It is a more intense pain and less of a stinging.

Although it does seem I am peeing less throughout the day than I was pre HoLep; I am still getting up about three times per night to pee.  And, I have not noticed any increase in the stream itself.  I am hoping I will see improvements in those areas as time progresses.

The leakage has decreased to a relatively minimal amount EXCEPT (and I find this a bit odd) when I pass wind it is almost always accompanied by a small "stream" of leakage.

ARRANGEMENTS FOR HOLEP:

I did a huge amount of research before deciding to have HoLep and before deciding on Dr. Lingeman.  This blog was influential as well as a few studies I found on line comparing HoLep with TURP as well as conversations with a friend who had HoLep done at Mayo in Scottsdale.

I had been suffering from BPH for about 15 years with symptoms getting gradually worse and worse.  I had tried several different drugs and most recently had been on both Flo-Max and Proscar.  I did not like the side effects nor did I like how scary it was when I went through a few episodes of "acute retention."  I am VERY wary of most doctors and all surgeries.  I began my legal career doing medical malpractice work and about 12 years ago I had a surgeon nearly kill me twice with a botched throat surgery...so I really wanted to avoid prostate surgery as long as the symptoms were bearable.  Nevertheless, once I began experiencing acute retention I realized I needed to do something -- and surgery was the only alternative.

At first I investigated the Mayo Clinic in Scottsdale because it is closer to my home (Northern California) and because my friend spoke so highly of the surgeon there (I forget his name now).  But, turns out I could not get it done there because of the nature of my insurance with Kaiser.  I was told that even if I were to pay cash, they could not accept me because of the type of insurance I had (I still can't understand this.)

When I called Methodist Hospital things were different.  I was told that if I had MediCare (I do) that Medicare would cover 80% and I would just have to pay 20%.  Also, I was told it all could be done on one visit.  I liked that idea, so I made the arrangements.

They would not begin to schedule me until they first got certain test info (the size of my prostate which was done with a "transrectal ultrasound" -- isn't that a horrible name?) and a few other tests.   Once they got those, Stephanie was told she could schedule me.  After being scheduled I had to get Dr. Lingeman four other test results within 60 days of the scheduled surgery.  (Things like an EKG.)

So many out of towners come to Methodist to get this done that they have a "concierge" service that offers you a couple of hotels at a discount rate and all of those have a free shuttle to the hospital.  That worked out well for my wife and I.  (However, note that the closest hotel with these arrangements - Sleep Inn - is located in a very industrial area and there is no restaurant or grocery store within a walking distance of the hotel.

A couple of other issues:

I mentioned above that I had been told by Methodist that Medicare would cover 80% of the expenses.  A week before the surgery someone from the financial office called and, long story short, medicare would not cover any of it because of the nature of my health insurance with Kaiser.  Seems their "Senior Advantage" plan is some sort of HMO and all my medicare benefits are assigned to them.  And, since they offered "alternative tranurethral procedures" they would not give me a referral to Methodist Hospital.  

So, I had the choice of canceling the surgery or paying for it myself.  I decided to pay for it myself rather than have TURP.  I have not gotten the bill yet; but I am told it should be in the $30,000 to $50,000 range.

So....that is probably more than you wanted to know about my experience so far.

A couple of questions for those of you who have been veterans of HoLep for longer than me:

How long did you keep your activities restricted after the surgery?  I am 66 years old and pretty active and healthy.  I feel like I could go back to the gym or play my usual 3 hours of tennis tomorrow....but out of an abundance of caution will put it off until a total of 2 weeks post op.

How long did it take post surgery for you to get relief from previous symptoms like having a slow stream and getting up a lot at night to pee?

Thanks for all your inputs!

RTandSQ

 

I had Holep procedure 14 days ago, I would like to know:
1-When do scabs start coming out? and are they dangerous in the sense that they are difficult to expel?
2-When will I stop leaking?
3-Why is it that in the night I have to pee in order to reduce my erection which causes me a burning pain in the prostate area?
Thank you to anyone for answering my questions
Propinor

For RTandSQ and Propinor. From my experience - I was doing dumbbell and indian club routines 2 weeks post-op; it was 6 weeks post-op before I was comfortable taking a 2-3 mile walk due to incontinence; I passed scab tissue at 3 weeks but it was soft and mushy no pain to pass; I had burning at the tip of my penis through week 10; at week 14 the incontinence was mostly gone; week 14 I could comfortably take a ride on a road bicycle for 35 miles. I still get up 2 or 3 times at night. During the day I usually go 2 to 3 hours between urinating sometimes longer. My stream was strong immediately after post-op recovery. Hope this helps. I pray for both your recoveries and for your patience as your bodies heal.

Big500 Thank you very much for your unfo. You are absolutely right, patience is the word
Thank you again for replying
Propinor

I am 5 weeks post op now. Leaking stopped after 3 weeks, stopped using a pad for protection. I still get occasional scabs coming out. That doesn't hurt, it sometimes blocks the urine but not for long and it shoots out with a strong stream. My stream was strong right from the day I left the hospital. I still get pretty severe burning feeling deep inside starting a urine stream. That passes quickly, then I get a mild burning as the stream is shutting off. I figure that the sphincter is still sore, so everytime it has to open or close, I get some pain. I go for my first follow up tomorrow with Dr. Kuo in Albany, NY. I'll let you all know if I learn anything new tomorrow.