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

Hello all,

I am now an official mmber of the HoLEP club. Not sure I am very happy about it just at the moment. After the surgery that I am told went well. I recovered overnifgt with a 3 way catheter. The naxt day when it came out I could only void 150ml and was leaving 275 retained. I tried for several hours and only got a little better. So to my dissappointment. I had to wear a cathater home for i hope only a couple of days. So tomorrow i have to go back to try again. Shucks!!

Hi jwb43,

   Sorry to hear about your set back.  I read that a smaller prostate is more likely to encounter this problem.  Did the Dr tell you the size of your prostate? Mine was 110 grams. about the size of a baseball, when it should be the size of a walnut.  The Dr removed 92 grams about 3 1/2 oz.  of tissue.  I believe I still deal with stress incontinence due to the size . Hopefully you not have to deal with my situation, and you will surpass me in this area very quickly. It is interesting to me , every person is a little different.  I do believe you will be glad you had this surgery . 

Hoping the best for you. 

Just me

Thanks Just Me. My prostrate was 60 grams. Not sure how much he took out. Since it was only 60 I wonder if I should have waited. But hopefully I will get off the cath tomorrow. But them I am sure I will be running to the bathroom every 15 min for the next few weeks. One silver lining is that I got 10 hours of uninturped sleep last night due to the catheter. I will post how it goes tomorrow.

And you should get that every night now. It's only when you stand up that the urges will come and that will go away. Do those Kegels (in bed before you get out of bed to get dressed and before you go to sleep) and you'll be fine. We're with you jwb.
(I won't see your reports till I return from vactation in 12 days but Just Me will ve here to coach you ;-)

Steve

 Hi jwb43

Dont second guess yourself.

    I know I waited to long and suffered the last  4 months before my surgery.  You can be glad you wont have to cath yourself several times a day because of acute retention.  I experienced that 70 times. I is a terrible feeling to have to go so bad but , it is impossible to go.  My first time for a catheter , I went to the ER in agony. I dont know what my BP was ,but my pulse rate was 162 beats per minute.  You will not have to go through that. You made the right decision.  It will only get better from here. It will take time , and it will take patience .   I see alot of my friends going through this at work lately. I am so glad it is over for me.   Dont let this time of recovery get you down  It will get much better for you too.

As Steve said , the urges come when you stand up. Dont go anywhere without a pad , as it will catch what you cannot hold.

This may sound crazy, but put one on and hold off urinating for as long as you can ,then urinate into the pad . This  will give you an idea how well they work. I was amazed .  This knowledge will make you more confident you are ok when you have to go and cant get to a bathroom in time.  I had to return to work 2 weeks after surgery. I wore the pad and changed it every 2-3 hrs.  They never failed me .

  If you have any questions Ill be glad to help if I can.  It is amazing how much this site has helped me.  Jonal and I wrote back and forth a lot . He was a big help. 

All the best ,

just me

Thanks for all the encouragement guys. I have good news to report. Yesterday I went to the Mayo and had a "fill and Pull". They took the catheter out and I could empty my bladder almost completely. What a relief. No more catheter. And now I have no urges, very little incontinence and very little bleeding. I only got up a few times last night because I am drinking so much during the day to keep the prostrate flushed out. I does hurt quite a lot sometimes when I go but other times it is mild pain. My main problem now is constipation. It is really bad every morning I guess from the surgery, drugs, etc... And lack of exercise. I was told not to strain to go so I am having to use a lot of laxatives that are not intended for long term use. Also something weird is that when I am trying to relax or go to sleep at night my pelvic floor muscles keep mildly contracting by themselves every few minutes. It doesn't hurt but it is unsettling. Did anyone experience that? Thanks again guys for all your words of wisdom and encouragement. It really helps. Steve hope you have a great vacation.

jwb43,

   I never had constipation ,  I did have those pelvic floor contractions a little.  it sounds like you are doing very well!  Most of the pain you experienc is when you urinate?  If that is the case it is normal. You will probably go through a period of time when you will feel no pain at all but in 5-6 weeks you will have another period of time when It will smart while you are urinating plus a couple minutes after.  It sounds like you are doing GREAT!

When the initial shock to your system is over You will be quite pleased to have this over with.

just me

Hi Just me. Prunes have become my best friends but they seem to be working. I walked for about 45 min yesterday. Half in the morning and half in the evening. I think that helps also. I felt good to get some mild exercise but not to much and I did not see much bleeding after. I do have a lot of dribbling at the end of urination and I am now noticing some "squirts" when I cough, bend over and things like that. Thanks for the tips about the pain that may come in 5-6 weeks. I know I still have a long way to go and lots of unknowns can still pop up to throw a wrench into the healing process. My stream still takes about 15-20 seconds to start and is only a little stronger than before the surgery. It seemed stronger when I first got the catheter out. Did yours get less for a while and then get better again?

Those Squirts  are from stress incontinence.  I still deal with that to some degree.

As I suspected, your prostate was smaller than mine.  When the Dr removed all my excess tissue, it left a big void even if there was swelling of the prostate capsule, so There was no obstruction at all.  I also had a to have the Meatus

{ opening of the urethra  at the tip of my penis}  enlarged as it was not large enough to accomodate the resectescope. It is like a straight shot out now.  I have never had it slow down or had to wait .  Dr Lingeman  told my wife Ill have him peeing like a race horse after this surgery. He wasnt kidding!

Your prostate is half as big as mine,so some swelling could be a factor, and your constipation issue could  also be a  involved.

Dont worry It wont be long before you will see a big difference.

On the plus side, you are not having a lot of urges, and your not bleeding . You will find you will be more free to do live your life than you thought.It sound like you are going to get through this very well. In fact you are doing better in some areas than I did!

I was leaking nonstop for a couple days, but incontinence was a relief for me compared to acute retention.  You should regain control a lot sooner than I did. I think waiting for so long with this big prostate id th factor 

Have you tried the pads? I still use them. I dont use the brief depends as they are less comfortable. 

It was my practice to urinate into a glass measuring cup for two reasons. 1 to monitor my output ,and 2 to look at what blood and tissue I was passing.

As I mentioned there is a time when there will be discomfort immediately after surgery, then it will be gone. At about 5-6 weeks  it will return as a result of the scab coming off at the surgery site.  It was strange ,as the pain did not show itself in the prostate area, but radiated into my penis. I experienced it only at the end and after urinating for a couple minutes. Then it was over. Not painful enough to take any meds . I never took any pain meds for the surgery at all. I was given a small dose of morphine in the recovery room and that was it.

UPDATE: I had to go into the Mayo ER last night and I have a bladder infection. Now on some strong antibodics and feeling lousy. They may or may not be the right Antibodics. They have to wait for the culture to grow. Dang it was going so good too.

jwb43 ,

MY computer is acting up . I posted to you but Im not sure if it made it through. I will check later to see if if it went through . If it didnt, I will repost.

 Hang in there You are in my thoughts and prayers   I really mean that .

Just me

Hey Just Me, I really appericate your thoughts and prayers. I seem to have some more leaking now. Maybe it is less swelling? But my stream is still not a lot different than before the surgery. I guess everyone is different. I am getting really restless not being able to exercise at all. I sure hope it will all be worth it in the end. Right now I am unsure. I guess because I never went through such a difficult time like you did. I thought It would be easier if I had it while I was younger. Doc said after 2 weeks I can start a little swimming. I am looking forward to that. How long has it been since your surgery?

JWB:

I am 6 months post HoLep with Dr. Lingeman-- today.

At 1st, I also was retaining 200 ml-for about 2 weeks. Then, very quickly, the retention was about 20 ml.

For a brief moment, we thought I had an infection--got it checked out  and there was none.  There was blood in the urine and then scabs were peed out.

I never used a single pad, no incontinence, and no major issues--but, we are all different.

I am fine now- have RE, but no big deal. Overall, an outstanding result. Things do improve but it takes some time.

Bill

 

Hello,

My husband has asked me to present a question.  He had holep precedure for an 80 gram prostate on January 15, 2013.  He has had absolutely no problems with the exception of incontinence.  He wears a male guard which he has to change every 2 hours and doesn't seem to be improving.  He did Kegal exercises post operatively but didn't seem to be helping.  His physician has scheduled him for a cystoscopy just to check things out and gave him rx for vesicare.

Has anyone had this problem and is there still hope for him being totally continent?

 

Thanks

jwb43,

 I had my surgery Oct 22.  9 months ago. 

I did not have any of the infection issues, but I stilll have stress incontinence . I will take that compared to acute retention any day of the week. More on that later! I will tell you now, you may not appreciate your surgery to the fullest.because you di not experience it. Take my word for it. You are afraid to go anywhere because you may be far from a hospital , and suddenly you cannot go at all. The pain is terrible. and there is no relief.  You made a wise decision.

 

 I never had a problen after surgery with retention. I emptied out every time from the start.  It is amazing to me how everyone is different and yet in the end they all seem pleased with the results. It amazes me that Bill never needed a pad at all.  I still wear them  and Im ok with that for now. It is only during my streneous job that I experience the leaks. Never at night or while sitting down.

HOPING AND PRAYING FOR YOUR CONTINUED IMPROVEMENT.

JUST ME