I read carefully the link provided by Buster.
Peter Gilling’s hospital HoLEP website has these frightening words :
“Approximately 10% of men may have a change in their potency (ability to have sexual intercourse).”
I have never seen this 10% rate for ED after holep anywhere so it is alarming.
He also said”Up to 90% of patients may experience retrograde ejaculations” and
“In a very small number of patients, approximately 2-3%, scarring can occur after surgery at the operation site as the tissues heal. Despite adequate removal of the prostate tissue, a ring of scar tissue can develop during healing at the neck of the bladder (‘bladder neck stenosis’) or within the urethra (‘stricture’), which may cause some renewed obstruction. In this unlikely event further day stay surgery would be required to cut through the ring of scar tissue using a resectoscope and the laser to open up the obstructing area. This short, simple procedure has a short recovery time.”
For comparison, Dr. Das gave a 5% rate for scar formation after holep.
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Hi DL,
I did some research on the anatomy of the bladder/prostate.
This article, clinical and functional anatomy of the urethral sphincter gives some information.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3469827/
It says, “On the other hand, in males, during ejaculation, the closure of the urethral sphincter prevents mixing between urine and semen and backward flow of semen into the bladder [33].”
This does not negate anything you have found. I suspect that the is a neve connection that connects the verumontanum to the bladder sphincter closing at the time of ejaculation.
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The risks are small and one of the points of this surgery is that you will not have ED. There is a chance you will not produce as much semen but you will have RE so that should not be a problem.
I hope the surgery goes well for you!
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Thanks for the article. I didn‘t know that the internal sphincter acts as a valve to prevent urine mixing with semen. This makes sense.
Bunt Not sure how the authors knew the internal sphincter also prevent semen from flowing into the bladder. To me this does not make sense because patients who have RE, their semen flow into their bladder. The internal sphincters of some of these patients are probably working.
These internal sphincters which are working do not,prevent semen from following into bladder.
So I am confused about what is the real situation. All we know now is if a BPH surgery preserves the tissues near the verumontanum, RE will be reduced to 10%.
My guess is that for a normal person, during ejaculation, semen flows forward and the internal sphincter is close, whereas for a person with RE, semen flows backward and the internal sphincter is opened. Not sure if u agree.
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So “losing potency” is not ED. Gilling meat RE, etc.
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I understand that immeidately after holep, one has to drink a lot of water every 2 hrs or so, so that blood and blood clots in the bladder can be flashed out from the urine discharge. But what happens when one goes to sleep, does he has to get up every 2 hrs to drink water and pee?
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Immediately after Holep, I understand that one must avoid exerting any force to the prostate in order to avoid bleeding. During this period, should Kegel be discontinued? If yes, for how long?
If anyone has time to share experience, I would appreciate it.
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I found the explanation for the need of Kegel illuminating. In RP, after the entire prostate is removed, the bladder neck is re-attached to the urethra. “activities such as lifting heavy objects, coughing, laughing, sneezing or getting up from a chair” “caused an increased pressure on the bladder. This pressure can cause an opening of the newly created bladder neck and then incontinenence”.
So the internal sphincter formed by the bladder neck is still the first line of defense. Pressure spike on the bladder breaches the first line of defense. Urine flows out of the baldder towards the external sphincter. The second line of defense is the external sphincter. Kegel strengthens the external sphincter.
The above situation is no difference than HoLEP if the bladder neck is preserved. If the bladder neck is not preserved, obviously the external sphincter is the only line of defense.
I believe that we all knew this all along. But is gratifying that the urology department of the Thomas Jefferson university hospital is saying the same thing.
Coming back to Kegel, According to this instruction, Kegel begins right after the catheter is removed. 10 times (hold contraction for 4 sec each time) every hours through out the day. This works out to be about one Kegel excerciwe every 5 mins. So it is intensive.
But it does not say when to stop. So it seems the patient needs to keep doing this Kegel routine until incontinence stops.
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For those readers who are about to have holep and worry about inconvenience and those who are having incontinence from HoLEP, they may want to consider the Jefferson’s overkill Kegel routine: 4 sec contraction every hour throughout the day, starting one month before holep till no more incontinence.
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BPH occurs often at old age at which time the Kegel muscle (the external sphincter is part of the Kegel muscle) often has been weakened.
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