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

Hello Steven,

I have not herd of that condition before. And have not seen a forum discussing it. Maybe a google search will turn up something. Hope you are well. My condition is the same. Not much improvement unfortunately.

jwb - it's still early. Have you learned to do the kegels correctly? That will help a lot. Me? I feel I'm 99% cured.

Steve

Steve, I thought Kegels were just for incontenance? I am OK with that. It's the orgasms that are not good.

Yes they are. Sorry JWB. As I pointed out Orgasms were not as important to me as incontinance and getting up 4-5 times a night. I think the others can help you with the orgasms issue. But hang in there, seriously.

The Avodart and Flomax were stopping any erections for me so it has been a while but erections are coming back.

Steve

I scheduled Holep surgery with Dr. Humphreys in Phoenix. He told me that most of the internal part of my prostate will be removed during the surgery, only shell will remain.

My question to you guys, who had Holep. I am wondering how much of your prostate was removed. Prostate produces DHT, hormone we all need. Dr. Humphreys assured me that adrenal gland will provide enough DHT, but I am not convinced. 

Sleepless,
DON”T TRUST THEM. On July 23th of this year I underwent HoLEP surgery at the Mayo clinic with Doctor Humpherys. Dr Humherys is a good surgeon and a compassionate man. But, Urologist really do not know some things.
For instance, I asked how RE would feel and was told it would feel about the same as it currently does.

After my surgery I have discovered that RE is not anything like a normal orgasm. It is very unpleasant and it is very devastating to my emotional and mental outlook on my future life and sexual experiences. It is also permanent and cannot ever be reversed. My body does not release the chemicals that it used to.

What I am missing is:
Prolactin: Prolactin relieves sexual arousal after orgasm and takes your mind off sex. It rises sharply immediately after orgasm in almost everyone. It's one of the few moments of the day when we men aren't preoccupied with sex.

Oxytocin, is known as the "cuddling hormone" because it causes you to feel a connection and bond with your lover. If you enjoy cuddling with your girl after sex, chances are you know the effects of oxytocin well.

Endorphins are a group of neurotransmitters formed within the body that bind to opiate receptor sites in your brain to naturally relieve pain. The bio-chemicals acetylcholine and dopamine are known as endorphins, and have a similar chemical structure to morphine. They are also known to lower stress and boost confidence. Endorphins produce feelings of euphoria and pleasure, and they have a calming effect. They fill you with a sense of well-being and relaxation. And you might even drift off to sleep.

When I told Doctor Humphreys this he just said he had never heard of this happening and it is not anything that he did. But I have seen a lot of doctors since to try and figure out what is going on and they tell me it had to be something caused by the surgery. But, no one knows what or how it can be fixed.

So my point is if they don’t even know what they did to me to cause this condition they can’t accurately tell you how it will affect the DHT levels.

Jwb43

Hi jwb

I am sorry to hear that your problem didn't go away. It is possible that your condition is due to hormonal changes, and not to RE. The fact is that we know very little about hormones interaction. That's why I was reluctant to take drugs like avodart or do the surgery. Unfortunately I have little choice, my prostate is at 155 g and growing. I just hesitant to get rid of most of it and want to keep enough to make the hormones.

I am wondering how big your prostate was before and after the surgery.

Hi JWB:

I am sorry to read your several messages and what you are going through. I also responded previously---for me, the orgasm is exactly the same--only it is dry. .. just as intense and with the same feelings.

Occasionally, a drop or two comes out--but, usually dry.

I have read all I can on the Holep/TURP/Greenlight/etc. and have never read about anyone having a similar issue like you. I have also read quite a few of the studies/discussed the procedure with Dr. Lingeman/ discussed with the local urologist, etc.

I am personally pleased with the outcome with Dr. Lingeman--I never used a pad-ever. No leakage. Some pain and some blood and scabs through the urine. Overall, I am pleased and recommend the HoLep to anyone (especially after reading the Topix and Greenlight sited).

Bill in CA

 

 

Sleepless,
Mine was 68 grams and I think they took out 40 something. I can’t bear to read the operating notes it makes me cry that it only took 25 minutes to screw me up so bad. But there is something called bladder neck incisions that they can use to open the bladder neck and still use the laser for the rest and not cause RE. Dr Swanson at the Mayo mentioned it.
The only reason I did not do it was because I would have had to wear a catheter for longer and take more antibiotics. If I knew then what I know now I would have done that. Good luck with whatever decision you make. I have come to discover that sex is not to important to a lot of men my age (60) But it was to me. There may be something to what you say about the hormones. But I wish I could find someone who could figure it out for me.

Hi jwb43, 

   Im back from running around .

 Sorry to hear You are still dealing with your issue.  I have read the kegals do improve the quality of your orgasm not just incontinence.  You might want to check with a Dr Trained in Hormones. It sounds like it is an issue for them.  I do experience a calming feeling after my orgasm ,but not for the length of time you describe.

just me

Thanks Just Me, I am looking into it with lots of different types of doctors. One ids checking hormones as well.

I had HoLep with Dr. Lingeman in Jan., 2013-- I am quite pleased with the result but do have RE. However, I am harder than before and the feeling is the same, only dry.

My questions to all Urologists out there and knowledgeable HoLep graduates/ interested parties:

                                   What exactly in the surgical process causes the RE?

Bill in CA

Guest, I am surprised that Dr. Lingeman did not explain this to you? This makes my point that there is not enought discussion about this condition prior to the surgery. You can alse google RE causes online. There are a lot of explanations on the web.

DR. Lingeman discussed that there is RE--but never exactly why during the surgery this occurs.

I have read that the internal sphincter at the bladder neck is damaged (eliminated?) by the laser and this lets the semen travel to the bladder rather than through the urethra.

Perhaps a more thorough discussion would be helpful with the Urologists-including Dr. Lingeman.

On the other hand, there was a great deal discussed, including RE.

What is your answer??

In one of your responses, you stated that Dr. Humphreys called DR. Lingeman and he never heard of your situation-- Dr. Lingeman has performed about 2000 HoLeps and brought the procedure to the US. If he has not heard of it, then you are in a unique situation.

I am a proponent of Dr. Lingeman and am quite pleased with the results (even with the RE). He is professional, friendly, has a great bedside manner, and is very competent.

 

 

 

 

Guest. You asked “what’s my answer” I don’t have one. The only thing I can think is that I just had more powerful orgasms and a more powerful “calm” feeling after than most guys. Maybe that is why I notice such a difference. What I do know is that I really miss it a lot. It’s was a wonderful relaxed calm feeling that really was euphoric for me. I pray it not gone forever but I am afraid it is. I am glad all is well with your recovery and you are happy with the results.