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

I haven't written in a long time, but I have been following all the entries to the site. DL, Buster and Blayneb, it's been mostly a conversation between the three of you, and I have found it interesting reading.
Dr. Lingeman performed my Holep two years ago when I was 79 at Indiana U. I hadn't done as much research as DL (your detailed research is most impressive), but I knew I wanted the Holep and at that time, Dr. Lingeman seemed to be the most experienced and successful surgeon for Holep. My prostate was about 90 grams. I stayed in the hospital over night, peed twice and was sent home.
I was incontinent and wore Depend pads every day for about 2 or 3 months. I never had an accident at night, but I did wake up about twice a night (and still do, but that may not be related to urination).
After about three months, accidental urination occurred much less frequently, maybe a few times a month. Now, after two years, I almost never have uncontrolled urinating. I only put on a pad when I anticipate not being able to find a bathroom if needed. For example, when I will give a public talk, which I do occasionally as a retired professor and because I am a Holocaust survivor and am asked to speak to schools and church groups. I have never had an accident during these talks, but it makes me feel more secure to wear a pad on these occasions.

Hello Learner,

Thanks for sharing ur experience and ur kind words! I remember ur previous posts.

“After about three months, accidental urination occurred much less frequently, maybe a few times a month.”
—- it is odd that Qmax reaches maximum at and after month 3 of holep. It suggests that at month 3 much of the raw surface has healed. Interesting fact.

“Now, after two years, I almost never have uncontrolled urinating.”
—- it seems that the last few percent of improvement takes a long long time like the tail of an exponent curve. Don’t give up hope, Buster and Blayneb.

“My prostate was about 90 grams. I stayed in the hospital over night, peed twice and was sent home.”
—- this is what the British Urologist Association website says. For most patients, the blood will be cleared within 24 hrs and will be sent home without catheter , except those with small prostates, for whom retention is a common complication and will be sent home with catheter. Right on.

“Dr. Lingeman seemed to be the most experienced and successful surgeon for Holep”
—- I agree. For HoLEP, if u pick the best, it will ensure success.

I certainly agree. I need to keep on top of it.

I had not used a pad for several weeks. I recently twisted my knee. As a result I have taken Advil before bed. I think it helps me sleep more soundly that leads to not waking up when I should.

Great, it seems that u had figure out the reason for each incontinence outburst. There is no reason to worry now. Also Learner had only a 90g prostate and it had taken about two years to completely recover from incontinence, u and Blayneb may just need a little more time to get the same result as he got.

Found out that my local urologist biiled my insurance company for about $670 for removing the catheter and 2 ultrasound to check urine retention.

Obviously, I had to talk to the urologist first else they won’t do anything, the conversation lasted about 5min. the Cather was yanked out by the nurse in one minute. Ultrasound took about 10 min each, applying gel and put the ultrasound head against the body.

My Insurance paid $170, the contracted rate.

The problem with healthcare is that once u walk in the the doctor’s office, u don’t know how much the doctor will charge u.

I wish you all happy holidays!

I am grateful that I got a lot of help from members of this thread, particularly Buster, Blayneb, Phillips and Learner.

Just got the bill for my HoLEP operation by Dr. Das at the Thomas Jefferson University hospital in Philadelphia. The costs are listed below.

Format: Billed amount $ (actual amount in $ paid by my insurance).

Hospital stay (about 28hrs) : 48,xxx(6,5xx)
HoLEP: 2,5xx(1,0xx)
Anesthesia: 6xx(35x)
Pathology: 200(46)

total ~ 52,xxx(8,1xx)

The major cost is from the hospital stay. Note also the huge difference between the billed amount and the actual amount paid by my insurance. If one does not have insurance, he can not afford to be sick.

Seems about right DL. If I recall, mine was close to $40K for a 1 night stay. And yes, the anount actually paid by insurance was much less.

Just curious, did your bill actually say "HoLEP"? I recall mine said "TURP with laser". I assume this was done to assure insurance coverage.

Learner - very encouraging for me to see that it took 2 years for you to regain continence (I feel for you as I am sure that was frustrating) as I just hit the 1 year mark and still lightly dribble/spot (maybe 2 or 3 times) daily. I am still really hoping I will eventually regain full continence and your experience helps to give me hope. Thank you.

I know I've been AWOL for a little while (busy with the holiday you know) but happy holidays to you, Buster, Learner and everyone here!

I think my total cost including hospital stay (but not including hotel and travel) was around $36,000. Whatever Medicare didn't pay, my Anthem policy paid. So I only incurred costs of travel and hotel.
Hang in there Blayneb. Time is on your side. Happy holidays to you and to everyone else on this site.

Any idea what was the billed amount and the amount paid by Medicare and anthem?

For HoLEP by Dr. Das, the billing was for “urinary surgery”. It didn’t say HoLEP, I believe it is the code that tells what kind of technique was used and in my case HoLEP.

I just looked up my records. The total was about $31,000 ($5,000 less than I remembered). Of that amount, Medicare paid about $25,000 and disallowed about $5,000. Anthem paid about $1,000. Remember this was two years ago, and I'm sure costs have gone up so it must cost more today.

Thanks for looking up ur record! The actual amount paid by my insurance was $8,1xx vs yours $26,000 which is more than 3 times as much!

Same operation, not sure there is so much difference.

Thus if one is paying out of his own pocket, it worths to shop around.

Medical billing is just plain whacko
Medicare negotiates contractual prices for everything.

Hospital costs:
IU charged 30,282.
Medicare paid 2,918
Supplemental Ins paid 744.

Surgeon costs
Dr K charged 4,246
Medicare paid 517.
Supplemental ins paid 132

Anesthesia
Dr. G. Charged 1768.
Medicare paid 216
Supplemental ins paid 55.

Pathology
Dr. Idrees 1100
Medicare paid 141.
Supplemental ins paid 36.00


Hi DL how are things after your first month?