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

Thanks for reassuring me

Bob good to hear it all goes away with some time. I will try some cortisone cream on the sore spot. I know in the end I made the right decision
Thanks

It is normal. You will have little threads of blood and tissue for quite some time. All part of the healing process. Sounds like you are doing great. Just me

From just me, If you have not read this whole forum , please do, I used this as a place to record my journal. It should help you have an idea of what is ahead. Glad to hear you are doing so well. I had the pain and discomfort for a while, but it does go away. It is possible you may have had to have the opening enlarged slightly. I did. It has been 4 years for me. I will take on anybody in a peeing race! They will loose!
Before I retired ,I went into the restroom and stood next to a friend of mine trying to pee. It took him forever. I was done, hands washed ,and gone ,while he still stood there. Later I told him about Holep. His Dr used a green light laser on him. He had some serious issues with it. We are very fortunate to have had the procedure and Dr. We had. just me

I agree with the last post. My friends that have had green light laser and TURP have all had problem 1 to 3 years later. I'm approaching 1 year and doing great.

I am seeking other patients' views on what might be the best time post HOLEP for me, to have a new baseline PSA. Pre HOLEP, it peaked at 16.9, with free PSA 5%; falling a few days later (diet only of orange peppers, nuts, broccoli .... the perfect PCa diet, said to suppress PSA in blood, though it doesn't cure PCa or stop tumours growing - just might stop them metastasing or slow their growth) to 9.7 total PSA, free PSA being 4%. It might be that I had prostatitis - my uro' declined to prescribe any antibiotics, but did think I had had it (but that it may have gone - diagnosis of it seems a little vague). Prostatitis could have made the PSA fluctuate. Anyway, those are bad numbers to have when your lil' 'ole prostate is only 22cc (albeit, ingrowing, causing slow flow and double voiding for years; I am 49), so you can't blame sheer size of the organ for the elevation .... so that triggered an MRI-guided transperineal needle biopsy (said to "miss" fewer tumours than rectal biopsies). He only took 13 cores, but had gone through the area where the MRI scan suggested (without certainty) possible cancer, and other areas of ambiguity. Clear biopsy result : no PCa but "chronically inflamed prostate". This lead to HOLEP 5 days ago, here in England. Awaiting the histology to confirm no cancer in at least the core material that was removed via HOLEP (I do realise PCa often arises in outer parts). Uro' suggested our one follow-up including new baseline PSA, be in just 4 weeks; I thought that a little soon, given that the remaining prostate may still be exhibiting prostatitis (I think most of it will remain; he said beforehand that he normally removes 40% with Holep, but when I asked for grammes caught in the basket after morcellation in my case, he was coy, wouldn't say - perhaps he simply hadn't weighed it, as it was late evening, all ops having run 2 hours late - but said a higher proportion gets ablated or vaporised with smaller prostates). So when his PA rang, I instead booked the appointment for +7 weeks, thinking that better for a stabilised baseline; any views on whether I might have done right ? Or given high previous PSA values, would I be more prudent to get what'll be my baseline test sooner, in case it's high ? (but that would just scare me, and I don't fancy another biopsy THIS soon....last one was just over 3 weeks ago). Easy to change.

One thing about surgery : they may give you oral morphine painkiller. That's good, but if they neglect to also give you a laxative, you go home the day after with constipation that is very hard to shift. And it makes recovery a little harder. Consider taking a stool softener for 3 days before surgery, or ask for a laxative the same time as oral morphine. Oral morphine slows down peristalsis in the gut. Laxatives take time to work once it has done that, so pre-emptive = good. (my Holep was 4 days ago, I am speaking from experience).

About your pain : I had my HOLEP this Monday at a private hospital (Princess Margaret) in Windsor, England, by Marc Laniado. I too had some pain previously in cystoscopy as the scope went through the prostate area. Just before cath removal, nurse filled and emptied the bladder 3 times using a really big syringe, with a very small nip of pain each time as she sucked the last drops out and the inside of the catheter nipped onto the edge of the empty bladder. It being clear in there, I was cleared for cath removal. I had marked pain (that made me holler out) as the foley catheter was removed post holep, but she whipped it out quite fast, so the removal process only lasted about 3 seconds. It was, with hindsight, not so bad. A lesser ache afterwards lasted 2 minutes. For 2 frightening hours in spite of drinking plenty I could not pee a drop, and feared very much its re-insertion. My prostate is only 22 cc, and I had read that this is more of an issue for small prostates due to swelling. Nurse said take a walk and stop worrying - declined my request for a bladder scan using ultrasound as it's expensive. Sound advice as it happens .... at last 6 drops came, with a burning at the end of the urethra, like after cystoscopy; nothing I couldn't handle, and I had the incentive of avoiding re-catheterisation through the operation site. Then I managed to pee 50ml, then 100ml next time, then 180 ml and they cleared me to go home. The post-cystoscopic type pee pain at the meatus, as flow is established, quickly ceased (within 12 hours) as urethra tip stopped being sore, but I was left with enduring deeper pain in prostate area mid and late flow, continuing up to now (+4 days). It has never been un-endurable; at first I allowed myself to shake and say "ouch" to cope a little better, now I don't need to do that as much and am mostly off paracetamol except at night. It varies a lot, occasionally one pee is almost painless, then the next 3 are bad again. I never used the codeine or co-codamol they gave (I had enough constipation from the morphine at the hospital, and didn't want any more). I found this mid-stream, deep-seated peeing pain was far less with dilute urine, and soon learned to keep drinking each of the 5 times I pee'd at night, or that pain spikes right up to a high level (concentrated urine on cut prostate surface ???), then you are REALLY wide awake! Never let the pee get strong, day or night. 4 days on I've learned not to sit, as sitting increases general discomfort unless you slump sideways onto one buttock. If you sit the need to pee comes sooner, and then the urge incontinence comes badly as you stand up, but ironically if you stand/walk, you can last much longer without the need to pee - I don't know why but that is how it seems to me. Kegel exercises are uncomfortable now, I should have done them more BEFORE the op (I did them somewhat, though).

Yes I have the same pain mid to end of the urination cycle deep in the prostate area. It is sometimes worse then other times, not sure why. It also does hurt to sit down for a long time, feels like a real bad hemorrhoid constantly inflamed.lol All the guys on here say that the deep prostate pain will subside with time. DR Lingeman told me it could take up to 3 months to completely heal form the surgery.
I am 10 days post op doing pretty good. I can almost sleep thru the night 5-6 hrs without having to urinate and my incontinence is almost gone except when I pass some gas. I am pleased so far with my progress.

hi Guys

I had my Holep surgery about 5 weeks ago with Dr Lingeman.  I was doing well ,no blood after 3 weeks, good stream, some pain while urinating and a minute or so after.  I had some incontinence, was wearing pads.

Now my stress incontinence has gotten worse.  If I am sitting I am ok, but when I walk around I can feel spirts of urine leaking into the pad.  Thru out the day  I have to change the pad 3-4 times when it gets wet.

I am a bit frustrated and concerned about this worsening of my incontinence over the past few weeks.  I still have some pain in the perineal area when I urinate.

I would hate to think I could have this incontinence remain permanently. I just had a urine culture done and I also have a urinary tract infection.   I'm a bit stressed about this.

Let me know what you guys think

Thanks

Bruce 

Took me 10 weeks for symptoms like yours went away. Be patient.

Thanks I'm just pretty anxiety ridden right now, with multiple medical issues.

Hi Bruce,

Have you tried Kegel exercises? Prior to my Holep I read the forum and they were recommended. I did them everyday beginning 3 weeks prior to surgery and had no incontinence at all. Many others began the exercises after surgery and it worked well to stop the problem. I am 2.5 months post Holep and I feel completely healed and feel as if the clock has been turned back 20+ years as far as my peeing is concerned. Best decision I ever made. See Dr. Das in Philly next month for full clearance.
Thanks,
Bob from South Jersey.

Bruce -

It was about 16 weeks for me before I was down to 1 pad per day, and those 16 weeks were a very anxious time for me. Kegels seemed to help - if nothing else doing them provided a sense of taking action. Now after a year and a half I only wear the thin style guard when going out in public just for "insurance". Most days the guard is not necessary. Godspeed.

big500

Had HoLEP performed by Dr. Lingeman at IU Methodist on 2016/7/11. Age - 44, good health.
Preop on 6/26 included flow measurement, cystoscopy.
Procedure was scheduled for 8am, we had to show up at 6am. Dr. Lingeman dropped by around 7am to have pre-op chat. They wheeled me into OR around 7:30am. I chatted with anaesthesiologist that propafol felt cold going in, then I woke up. Procedure lasted around 1.5 hours, doctor removed 40g of prostate tissue, bladder stone, and resected bladder neck.
Catheter was removed on 7/12 around 4am. I urinated on my own at 6am ~150ml, 6:30am ~200ml, and ~300ml at 7:15am. Dr. Lingeman checked up on me around 7:30am, initiated discharge process.
I was back in the hotel around 11am. Spent the rest of day snacking, snoozing, and urinating, sometimes passing clots. Quite a bit of discomfort and burning in my urethra/penis. Urine was mostly clear towards the end of the day.
We drove back, around 5 hours, on 7/13. The drive was uneventful.
So far - pathology was negative, flow is unbelievable, urine is clear. Frequency and urgency is less than pre-op.

Tips for procedure and IU Methodist -
Use concierge service, it will save you money. We stayed in Candlewood Suites - basically, a small one bedroom apartment. I was able to sleep in the bedroom while my wife was taking care of her work. It had small kitchenette, dishwasher, etc. Kroger supermarket was ~ 5 min away.
If you have any body hair, consider trimming it a few days before procedure - removal of catheter holder and IV line was quite uncomfortable. Catheter was attached to thigh area, IV line to forearm. Nurse told me that it is even worse if catheter is attached using just adhesive tape.
Discuss taking stool softeners with your doctor before the procedure.