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

I would appreciate seeing the replies to question posed by jayp as I am consideribg HoLEP and am wondering about retrograde ejaculation and impotentcy as side effects? 

 

I had HoLEP 15 days ago. Painless, very rapid recovery from the initial procedure (133cc of material removed). Bleeding stopped in 4-5 days and the entire post-op experience has been painless. I'm still wearing a diaper to contain dripping/leaks, so I'm not fully able to control things yet, but I DO get the urge to urinate when my bladder is full and when that happens, it's a perfectly normal void (high flow rate, high volume). Frequently, however, I get a small 'squirt' when I strain/cough/sneeze and I do still have a frequent drip. I can tell it's getting better by the day by the voume that slips out getting smaller by the day.



I had had a catheter for two months prior to the surgery, and had not had an erection for that entire period, but I started getting 'semi' about a week after the procedure. I'm able to get fully erect yet, but I things seem to be moving the right direction and my libido is returning. I'm 58, and feel confident that improvements in this area will continue.

I am a 59 year old physician and have posted elsewhere my experience with HoLEP so I will summarize by saying that I had it done by Dr. James Lingeman at Indiana University in Indianapolis 8 months ago and it was a great experience. I flew there the evening before the day of surgery and was discharged from the hospital after an overnight stay. Aside from retrograde ejaculation I have had no side effects and am "peeing like a race horse". What a relief after 15 years of misery! Dr. Lingeman brought the procedure to the US over 10 years ago after learning how to do it from the originator of the procedure in New Zealand. He has a vast experience, including performing it on very large prostates, such as mine was. In fact, my local urologist recommended that I have an open prostatectomy. Because of its steep learning curve and the fact that hospitals don't make much money on the procedure, HoLEP has not caught on in a big way in the US. This is very unfortunate because in the right hands it is a very safe, quick and effective treatment for debilitating BPH symptoms.

A comment about retrograde ejaculation: Retrograde ejaculation is a common side effect of most surgical procedures of the prostate because the internal sphincter at the bladder neck is damaged. Yes, ejaculation feels a little differently, but it personally doesn't bother me and has not affected my orgasmic pleasure. I believe it is really more of a physcological issue for some men. As a very actice person, being able to urinate like a young man again far outweighs any perceived negatives about having retrograde ejaculation.

I am 74 and had HoLEP four months ago. I managed until than urination by Kegel exercises and diuretics. Research of BPH treatments worldwide from Mayo Clinic to India, German, English, Spanish etc showed me incredible differences in approach and treatment. I eliminated TURP, which in my opinion is a butchery, Green Laser also for deeper penetration (more damage) and side effects. Holmium appeared the best and most permanent solution. Costs range from $3000 in India Delhi Hospital to $36,000 at Mayo and India surgeons did many more surgery experiences. I narrowed down all surgeons in North America and Europe, some did not bother to reply, some were very pleasant and cared. I chose Dr. Alfonso Santos who performed very successfully many enucleations in Spain using newest Holmium Laser and laparoscopic head. My prostate was 80cc and I stayed 3 days in Clinic for cleaning of the bladder after morcelation. After a week I had no bleeding, and peed very nicely. Now, four months after I have no problems of incontinence, erection, retrograde ejaculation although volume is lesser as prostate adds fluid. Clinic personel were fabulous, Dr. Santos most cordial and friendly. I cannot thank all enough. Fees totaled $ 14,000. Good luck to all who search BPH surgery.

I am a 69 year old businessman and my son is trained urologist.After using flomax for 5 years my son talked me into seeing dr liingaman and he performed holep on me in 2008. I was in hospital one night and have had excellent results . I highly recommend it.

I was on catheter for 6+ months because of acute urinary retention.  Tried meds to control problem, without success.  After researching surgical alternatives, concluded that Holep was as effective as any, but with far less incidence of collateral damage or post operative discomfort/complications.

Hello Cedar88,


My father is 74 years old and has been catheterizing himself for greater than 6 years post 2 TURP procedures. He is miserable to say the least. I am a physician myself and have compared BPH procedures. After doing considerable research, it appears that HoLEP is the best treatment but of course I'm concerned about making a mistake with my father's health. I don't want him to undergo a procedure that may potentially cause impotency as my folks have been happily married for 52 years. He has a very large prostate and was told the only other procedure that would work for him (other than TURP) was open prostatectomy, which has the potential of causing impotency. This is a great fear of his. In addition to cathing himself several times a day, he also bleeds on occasion.


How are you doing 6 months out? Do you have any regrets? Why did you choose Dr. Lingeman instead of the Dr. Amy Krambeck at the Mayo Clinic? Any feedback you can provide would be great. Thanks for your time.

dear doc truth
I am a urologist myself performing HoLEP and open prostatectomy in Switzerland.
Impotency can occur in both operations but usually fully recovers. I guess, the neuropraxy is mainly a problem with larger dorsal and apical perforations of the capsule during surgery with consecutive cautery. In open prostatectomy, I do a suture of the bladder neck and place the catheter inside the prostate with tabotamp. In HoLEP, the heating of the capsule and also perforations can be the issue. This can always happen but usually without any consequences.
I would advice your father to undergo the operation because it gives him lot more quality of life and the possible impotency can be treated with Tadalafil if necessary. Orgasm will be dry though.
Before performing a 3rd operation I would suggest to do cystoscopy and urodynamics. Elder people tend to have a lazy or even dysfunctioning bladder after years of retention and chronic infections with scaring. But when he decides to undergo the operation, a radical enucleation should be performed and not a "semen-protective" partial TUR-P in order to lower obstruction a much as possible.
After complete enucleation, he should not underrate the risk of (temporary) stress incontinence (up to 15%) and performing a HoLEP on previously catheterized patient can lead to severe infections up to sepsis, also with multi-resistant bacteria he acquired somewhere in a clinic. So make a work-up with urine lab and cultures and he should be given a broadband single-shot before operation.

Mikey313,

Thank you for your reply! I've spoken to some other docs I know, one that did his residency at Mayo and he echoed your thoughts. I had not thought of lazy bladder although my Dad is as healthy as a horse except for this. He's never been sick a day in his life, has no other co-morbid illnesses except HTN and despite all this cathing, he's never had a UTI, still very muscular; he is Portuguese and they seem to be built Ford tough.

The urologist who originally performed the TURP procedures thankfully never touched the capsule. He said it was the largest prostate he had ever seen so we need to get records from him before proceeding.

We know lots of folks in Switzerland so it's not out of the question to come out your way as well. My parents have been there many times.

Again, thank you for your time,
D. Truth :)

You said "Dr Kuo has a reputation for being highly proficient in the Holep procedure, and, painstakingly thorough."
Could you please tell me the source that you got this information from?
Thank you

Shrasts,
Are you still trouble free after 5 months?
I'm thinking of seeing Dr. Kuo also.
Can you provide me with any more further data that can reassure me about his credentials that puts him in the "expert" catagory?

Does anyone know the approximate cost of the HoLEP procedure if one is paying for it out-of-pocket ? Thanks.

 

Thanks for the info on the varying costs that you encountered in your research. Could you share some more details about this and how you managed to get answers about what the various clinics charged for HoLEP ? I am having great difficulty finding answers in this area.
Also, is Dr. Santos located in Spain, or did I misunderstand your explanation ?
Did you ever seriously consider going to India for this procedure ? Wow, what an adventure that would probably be ! I must admit that idea interests me. Am I crazy for considering it ?
Thanks.

The above reply was supposed to be specific to ricori, the 74 year old gentleman who writes of his experiences above, but it just got sent to the bottom of the list.