Thanks Buster. When you say you didn't wait does that mean you only had moderate symptoms at the time?
Thanks, Philip. What were your original symptoms at the time you got HoLEP?
I'd also add that I did read your early posts and I wonder more about your preop symptoms. I never had a near obstruction except 9 years ago after my gall bladder was removed they sent me home too early and I had to return in the middle of the night to be catheterized since the anesthesia hadn't worn off. My urologist estimates my prostate at about 130 grams. I did have a cystoscopy and my median lobe "isn't too big but my anterior and posterior are quite large. I'm very active still (I run and work out in the gym regularly. I'd like to hear more from you and others.
Dan
Moderate is a relative term. I was having issues but I was not incontinent nor was I in urinary retention. HoLEP will leave the patient with life long sexual dysfunction. If that is not an issue for you then go for it! The surgery is almost virtually painless and with exercise the incontinence should resolve itself.
One additional fact, my prostate at the time was about 100 grams.
Contributor
149 posts
Daniel:
I had all the same symptoms that you say you are having. I also had all the same worries (ie: worries that I was doing it too soon).
One difference is that my post-void was 150cc. And, despite the symptoms my prostate was only 75 grams. So, I was having a fair number of symptoms despite the relatively small size of my prostate. Probably the biggest issue that put fear into me was the fact that I do expeditions, on a sailboat, into the North to very remote places that tend to be rather cold and where any medical resources are at least days and even weeks away. Several times when I got very cold I had significant difficulty voiding. I did not ever want to consider the consequences if I could not void and could not get medical attention. But putting that aside, I am still very glad that I went ahead with Holep.
To my surprise, during the pre-surgical ultra sound the doctor pointed out that the inside wall of my bladder was all rounded ridges. She also noted a couple of small diverticlar like pouches beginning to form in my bladder wall. She said that both these issues were signs that significant damage had already occurred to my bladder and that Holep was indicated. She verified my subjective feelings that I was not jumping the gun.
I believe (personal opinion) that bladder damage from waiting too long is one of the primary reasons that some people have more post-op complications than others. As it turned out I had very minimal post-op complications. Also, I (and I believe most people) did not have any issues with sexual function other than retrograde ejaculation. I must admit that I do miss the strong ejaculatory sensations but I have no problems performing and my wife humorously adds that one benefit is that there is no mess.
I had never had surgery before and was scared to death. But in reality it turned out to be a "non-event." I went to sleep - I woke up in no pain - I spent the night in the hospital with a very large three way irrigation catheter (during that time I was extremely uncomfortable and miserable due to the catheter) - Early in the morning the catheter was removed - I forced fluids and subsequently voided large amounts several times without any difficulty and was discharged to our hotel nearby. Of note: the first void is very bloody and with some small clots. Also I found it very useful that I took my urinals with me upon discharge because initially I did not shoot straight and would have made a big mess without them.
I also recommend having the procedure done in a teaching institution if possible and done by someone trained by Dr. Lingeman.
So, in closing I can think of no reason that you should wait.
I had all the same symptoms that you say you are having. I also had all the same worries (ie: worries that I was doing it too soon).
One difference is that my post-void was 150cc. And, despite the symptoms my prostate was only 75 grams. So, I was having a fair number of symptoms despite the relatively small size of my prostate. Probably the biggest issue that put fear into me was the fact that I do expeditions, on a sailboat, into the North to very remote places that tend to be rather cold and where any medical resources are at least days and even weeks away. Several times when I got very cold I had significant difficulty voiding. I did not ever want to consider the consequences if I could not void and could not get medical attention. But putting that aside, I am still very glad that I went ahead with Holep.
To my surprise, during the pre-surgical ultra sound the doctor pointed out that the inside wall of my bladder was all rounded ridges. She also noted a couple of small diverticlar like pouches beginning to form in my bladder wall. She said that both these issues were signs that significant damage had already occurred to my bladder and that Holep was indicated. She verified my subjective feelings that I was not jumping the gun.
I believe (personal opinion) that bladder damage from waiting too long is one of the primary reasons that some people have more post-op complications than others. As it turned out I had very minimal post-op complications. Also, I (and I believe most people) did not have any issues with sexual function other than retrograde ejaculation. I must admit that I do miss the strong ejaculatory sensations but I have no problems performing and my wife humorously adds that one benefit is that there is no mess.
I had never had surgery before and was scared to death. But in reality it turned out to be a "non-event." I went to sleep - I woke up in no pain - I spent the night in the hospital with a very large three way irrigation catheter (during that time I was extremely uncomfortable and miserable due to the catheter) - Early in the morning the catheter was removed - I forced fluids and subsequently voided large amounts several times without any difficulty and was discharged to our hotel nearby. Of note: the first void is very bloody and with some small clots. Also I found it very useful that I took my urinals with me upon discharge because initially I did not shoot straight and would have made a big mess without them.
I also recommend having the procedure done in a teaching institution if possible and done by someone trained by Dr. Lingeman.
So, in closing I can think of no reason that you should wait.
Hi Daniel415, I'll throw my 2 cents in here. I think Phillip's reply is pretty much spot on. Though my symptoms were quite manageable for years, waiting as long as I did probably did me a disservice. When I saw Dr Das in Philly, he indicated that the length of my 150 prostate might make things difficult (might be too long for the instruments). Luckily, due to his skill and vast experience, he was able to complete the procedure successfully. I am 6 months out and at this point, am down to small dribbles, I wear one light shield a day, and hope to be free of those sometime soon since things are progressing well. I am sure due to a lot of manipulation that Dr Das may have had to do, my incontinence is a little more than many others here. You could probably avoid possible complications such as these by not waiting (just my 2 cents).
As Phillip says, I don't consider retrograde ejaculation to be sexual dysfunction. That seems to be the maximum extent of sexual side effects for most here, though as you have read, there are some exceptions (everyone's case and how they handle it are different). If you're in PA, you may want to strongly consider Dr Das at Jefferson Hospital in Philly (which is a learning hospital, why they are one of the few that do HoLEP). His manner is great, and he has done thousands of HoLEPs. Good luck, and if you have any questions, please feel free to ask.
As Phillip says, I don't consider retrograde ejaculation to be sexual dysfunction. That seems to be the maximum extent of sexual side effects for most here, though as you have read, there are some exceptions (everyone's case and how they handle it are different). If you're in PA, you may want to strongly consider Dr Das at Jefferson Hospital in Philly (which is a learning hospital, why they are one of the few that do HoLEP). His manner is great, and he has done thousands of HoLEPs. Good luck, and if you have any questions, please feel free to ask.
Thanks Blayneb, Philip and others who have responded to me. I'm pretty sure I'm going to go ahead. I'm still a bit worried that if my bladder capacity is only 150-200 cc (my urologist said it's because the walls are thickened and muscular) that the HoLEP won't really change my frequency. But , I guess the big thing is to do it before I get obstruction and retention some day. My wife really worries about potential side sexual side effects and the incontinence. Though my brother's incontinence resolved in less than 4 weeks. I'll let you know what I decide. My doc trained with Dr Das and has done about 200.
You're sure welcome Daniel. If it helps, I too have very thick bladder walls due to years of forcing urine flow because of my BPH. Post HoLEP, I now go all night (6+ hours) without the urge to go. And when I am active, I can usually go a good 4 hours or more without the urge (though of course increased fluid intake sometimes shortens that). It is definitely a vast improvement over my pre-HoLEP days, and all in all, I am very glad I did this. Is it perfect? No, but the other options were simply not sustainable. Hopefully you can reach a conclusion that works out for you and your wife, whether that is HoLEP or not. Either way, I wish you the best. I actually traveled to Philly from DC and stayed in a hotel in order to use DR Das I think so highly of him. If you surgeon trained with Dr Das however, odds are pretty good I'd think that your outcome should be optimal. Good luck!
Thanks....I spoke to my doc and am now scheduled for July 16th...unless I chicken out.
Contributor
149 posts
You will not regret it and you are doing your body a favor in the long run.
Hi Daniel, What is the microwave treatment? Maybe that would be safer for my dad. Thank you
Hi Dan, what is the microwave treatment? Maybe that would be safer for my dad.
That was Buster who posted about that, not me.
It is a non surgical therapy that reduces the prostate tissue through heating. I had to have a catheter for about a week after the procedure. I had it done in my urologist’s office. To find out about it google TUMT (trans urethra microwave therapy). It is not permanent but it kept me going for over ten years. You really need to talk with a urologist or two.