I am now 4 months post HOLEP.
This week I had my first flow test and PSA level and I am delighted with the results.
My peak flow was 24 mls. The mean was 14 mls. Voiding time was 11 secs. Flow time was 11 secs. I had residual urine post voiding of 108 mls, but I feel that this aspect of the test was not done properly, so I am not sure If I have a hypotonic bladder or not.
My PSA level was 0.8 which I am absolutely thrilled about. I used to fret over my PSA levels. The highest point was a PSA of 6.4. It had dropped to 3.0 in November 2012 after about 2 years on Finasteride. When on Finasteride the PSA level should be doubled so theoretically it was 6.0. A maximum PSA reduction of 86% is what is desirable after HOLEP, and I fall into this desirable outcome.
Improvements in the above stats are expected up to a year post HOLEP, so they should get even better.
My flow is excellent. I have no dribbling or incontinence. My frequency is good. I am only getting up once a night for under half the time. I can hold and wait without the urgency I used to experience. At the moment I still have R.E. but that too may change, anyway it is not a deal breaker. All in all a most successful outcome. My only regret is that I did not have the opportunity of HOLEP a few years ago.
I hope my experience helps others to decide.
As previously, my only word of caution is to make sure that you chose a thoroughly experienced surgeon.
Six week checkup with local urologist after holep with Dr. Lingeman in late January. After voiding, only had 19ml in bladder
I also have IBS now and that is more bothersome than the incontinence. But, like you, I’m hanging in there and thankful for the surgery.
After fighting off four different urologist who insisted upon using TURP, I finally settled on Dr. Humphreys at Mayo Clinic in Scottsdale. Wore a catheter for 10 months prior to undergoing Holep. The surgery was painless, the treatment received was superior to anything in my experience thus far and I'm 70. Bleeding stopped in 5 days and the catheter was removed at 7 days. No problems since. No leakage, or need for any unusual underwear. My sex life has returned and the only side effect is the retro ejaculation which takes a bit to get used to but is really no problem. I highly recommend the Holep and especially Dr. Humphreys. During my 1-day stay the nurses were commenting on his successes and the fact that people are coming from other countries just for his expertise.
jonal,
I never had a test with any of the results that you describe.
I had a bladder scan and PSA but none of the other tests. I do know I normally empty out 250 mls in 8 seconds. I timed myself !
What are these tests and how are they done?
just me
Hi just me,
The test is called a urine flow test or urinometry. Basically you urinate into a special container that is hooked up to a machine. Various measurements are taken throughout your flow and graphed. Individualised stats are given at various points in the flow which provides objective analysis as to how well you are urinating from beginning to end.
The urology department was also able to compare my pre and post operative urine flow.
If you Google 'urine flow test' you will find various male flow statistics. It is useful to compare your personal range of stats. I was delighted to find that my flow was comparable with that of a man in his 30s to 40s.
One thing I was not pleased about was the bladder scan, which I think was messed up. Now I am not absolutely sure whether I have urine retention after voiding, or they totally messed up the procedure.
I had a positive reinforcement this week. We were at a restaurant and I went to the toilet just prior to departure. When I got there a man I would gauge to be in in his very early 40s was already at the urinal. Although he was there before me, I completed, then washed and dried my hands went to the cloakroom adjacent, retrieved my coat, put it on then observed him just leaving the toilet. This was a complete role reversal of what used to be! I now also have to wait for my wife, which is a dramatic change.
I would be very interested to know the figure for your next PSA test, as a comparitor for my one. Considering the size of your prostate and level of previous PSA tests, I was amazed at your initial excellent PSA result and was puzzled why they did it so soon after your op.
If anyone else who reads this has had HOLEP, I would be interested in other PSA results in relation to the timescale post op.
I'd just like to offer a word of warning, not about holep, which is wonderful, but about Finasteride (Proscar). In 1999, the research center at USC determined that this "medication" INCREASES your chances of getting the most aggressive form of prostate cancer by 300% and breast cancer by over 30%. They give it to you to shrink your prostate and it takes at least 6 months for it to do so. Once I discovered this, I threw out finasteride and flomax and my doctor prescribed Cialis which shrinks the prostate faster without the nasty side effects as well as providing other benefits. For anyone who is considering prostate surgery, I highly recommend you look up Ben Ong on Google, a British biochemist who is more knowledgeable on the subject than any doctor I know, and whose information saved my life. His book "All About the Prostate" is a must.
Well the good news for those of us who had HoLep is that we don't need Flomax (Tamusolin) or Avodart (Finisteride).
BTW I'm doing my Kegels but no change yet and off the urge medicine and no noticing any difference. I do notice that when I drink any liquid it goes through me pretty quickly - probably 15 minutes or so after drinking. But most nights I'm not having to get up except when I wake up for other reason and stand up. THEN I have to urinate.
Jonal. Sounds like you are continuing to improve.
Since being treated by HOLEP I no longer take Finasteride. The 1999 study is now quite dated, there have been more recent studies on its possible carcinogenic effects. The conclusions were that it was due to investigative error concerning prostate cell analysis. There are also ongoing studies on the cancer preventative potential of Finasteride.
As I mentioned previously I tried alternatives like Beta Sitosterol and Permixon etc. Whilst they helped urination to some extent, they did not shrink the prostate. The problem is that the prostate continues to grow with age and has the potential to become more obstructive to the point of kidney damage and a hypotonic bladder etc.
From my limited reading on Cialis it has a similar beneficial effect on urination as these drugs and particularly helps with E.D. in some men, but does not shrink the prostate. Perhaps you can direct us to some published medical papers that says otherwise concerning shrinking of the prostate.
I am not at all advocating Finasteride. I opted for HOLEP to avoid taking any more medication of any type. I do, however, advocate independent research into credible medical/scientific papers on these various drugs. There are too many vested interests recommending prostate treatments that are not all that effective, but have significant money making potential.
The 1999 Norris Cancer Institute study may be dated but if the conclusions are wrong, why did Canada just issue a warning to all Canadian urologists for the very same reasons? Finasteride can artificially lower a man's PSA levels by as much as 60%, and has the potential to decrease libido and cause premature ejaculation and impotence. What they don't tell you is that this drug can cause birth defects in pregnant women who come in contact with the drug or even with the sperm of a man who has taken Finasteride. In addition, it is designed to shrink greatly expanded glandular tissue of the prostate, but not all BPH problems come from this cause. Some men have prostrate glands that are normal in size but because the smooth-muscle tissue in their prostates has begun to contract around the urethra, they too suffer from painful BPH symptoms.
My PSA prior to surgery was 19.8. One month after surgery: 2.3.
Gentlemen, those recent comments were very interesting and I love how much research some of you have obviously done on this topic. One thing I don't understand, however, is how concerned many of you are about your PSA reading. As I understand it, this test has been pretty thoroughly discredited as a predictor of prostate cancer. I am not being critical of your emphasis on this test..........I am just looking for clarification. Are you using these PSA numbers for some other purpose as they relate to the HoLEP procedure ? Thanks.
As Steve said, Finasteride and any other prostate drug is thankfully not part of our post HOLEP lives anymore.
I am aware that Finasteride lowers PSA levels that is why I opted for the plant based alternatives first. However, it is still possible to monitor PSA levels reasonably accurately at the new base line. It does decrease libido, I can confirm that. I am also aware of possible birth defects. In fact pregnant women should not even handle Finasteride pills. It is not on the same level of threat, but men should not handle HRT patches either!
At a basic non scientific level, there is a sizeable group of men out there who have been taking Finasteride regularly for hair loss, and this has been ongoing for decades. I don't believe that they are dropping like flies with prostate cancer. They are aware of the side effects, but due to the vanity of preventing baldness they continue with the drug. It seems that lowered libido is preferable to hair loss! You also have to look at statistics in absolute number terms rather than percentages. The medical journalists have led to many post menopausal women having a really hard time by coming off ERT due to percentage statistics, which distorts the risks.
I would not want to further argue the case for Finasteride, so I wont, but all drugs have side effects. It is always a question of balancing the good outcomes with the bad, there is always a trade off. I try to avoid any medication where possible, because of this, but sometimes you have little choice. I do my research first, and thus I always accept personal responsibility for my choices.
Hi Steve,
I can only encourage you to keep with the Kegels religiously. Perhaps try and do more of them if possible throughout the day. If after another few weeks there is no improvement at all, you should have further investigation.
jonal