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

Update from LAS2002
I am 4 weeks from HoLEP today and continue to do well. Bleeding stopped 7-10 days ago and flow is good. I still have some urgency sometimes even after urinating. I have very minor dribbles sometimes but its so few that I wouldn't even consider it IC. My girl friend and I have played around but no real Sex yet - probably this weekend. I was waiting until 4th week and all bleeding to stop for at least a week. I'm there now. I still have some tenderness in the lower abdomen and sometimes an almost itching sensation in the tube behind the scrotum. Also, some very slight discomfort in the urinary tract during or after urination. Overall, I feel that I'm doing well but some days it feels like I regress a bit vs. the previous day. Are any of you taking a multi-vitamin during early recovery?

July 2, I had the HOLep at the Mayo in Scottsdale.  I'm pleased.

My BPH went on for 18-years (starting when I was 49) with AURs, 2x daily catheterizing and a 200cc prostate.

Called them initially in March and was going to finish a backpacking trip in NM late May so after the initial screening on the phone and being accepted for a face2face, picked up my wife at the Phoenix airport and met with Dr. Humphreys.  He was supremely confident and told me he had done more HOLeps than anyone in the country.  The prostate was described as an orange from which the pulp is removed and the rind left behind.  The space previously occupied by the "pulp" was now a widened section of the urethra.

I got a call within 48-hours of my meeting with Dr. Humphries that I was accepted for the procedure.  There was a biopsy in '95 and a few color-dopler-sonograms since then.  No evidence of cancer.  My PSA had been 36 a year ago and then for some reason dropped to 16 in April.

I went backpacking again in late June and went to Scottsdale June 28 for a day of testing to see if there were potential problems.  For that reason I chose not to go to Dr. Lingemann.  I had to have 8-different tests 4-days before the procedure.  Failure of the tests would cause need for re-evaluation.  One of the more important tests was testing bladder elasticity to see if it would push urine out by itself with all this new room it would have after having the prostate size reduced.  After being probed with one test involving catheters placed in the two orifices I generally try to protect the most, being placed in a chair that resembles a gynecologist chair with stirrups, having to bend over to . . . well never mind, I was cleared.  In every step the courtesy and professionalism of the Mayo Clinic shone though.  I was done with all the testing before noon and free to wander for 4-days.  I went to Talliessen West and learned enough about Frank Lloyd Wright and his life to last me the rest of mine.  I drove to LA to have lunch with my son and drove back the same day.  I drove to Tombstone to see the OK Corral.  It wasn't as cheesy as I thought it'd be.

I kept busy because in the back of my mind were a couple of things Dr. Humphreys told me.  First that there was a 1 in 8 chance that my "pulp" would be as tough as "vulcanized rubber" and they'd have to make an incision.  That word was delivered in sotto voce probably hoping I wouldn't seize on it like I did.  I was proud that I asked without my voice squeaking "An incision?  Through my stomach?"  He said it would be lower.  I gulped and nodded.  The second is that there would be a chance of mortality.  Euphemisms are endemic to the medical profession.

I got my wife from the airport the day before the procedure and the next morning I went for it at noon.  My wife waited in the waiting room with regular growls towards the easily intimidated desk staff for what should have been an hour and a half procedure.  After 3-1/2 hours she was ready to call out the state militia to get answers satisfactory to the scientist and wife she is.  Dr. Humphreys decided to remove a bladder cyst and although I never got the new analogy, I gather my prostate tissue was somewhere between orange pulp and rubber.

I woke up quickly and from 4:30 that afternoon until we left the next day at 11-AM, there was a nurse in the room every 10-minutes.  A woman came in at 9-AM and gave me a paper that said the procedure was covered by Medicare.  The catheter had been removed at 8-AM and when Dr. Humphreys came in he said that I could leave as soon as I could pee on my own twice.  That didn't happen, so I catheterized, put on a pad and we went to catch our flight.  Spending all that time on airplanes wasn't the ideal post-op activity (inactivity?) but home is where I wanted to recover.

Every day has been an improvement since then.  Anaethesia slows bodily functions down and bowl movements were non-existent for 3-days until a mixture of kefir and 16-gallons of psyllium husk cleared the way.  Since then things are good.  Since we had recently moved and I have over 6,000-books I would have been smart to wait until the third week to move many of those boxes but I need order.  On days I moved boxes there was more blood in my urine.

I had scheduled a kidney scan well before July and had that 3-days after the procedure.  It included a void test and I was told I only had 47-cc of urine after going.  When I spoke with a doctor at the Mayo Clinic she said that was excellent.  She said that while she was telling me that the biopsy showed no cancer.

Male urges and function are improved.  Voiding is fast and doesn't require standing there visualizing Victoria Falls and laughable comparisons.  My wife is kind and makes references to race horses.  I'm down from 2-pads a day to 1 only if going to someone's house for the evening.

I went for a follow-up 10-weeks after and my void test was 0-cc.  The dr. was pleased and as he rushed out he suggested I return in 6-months.

No bleeding but occasional discomfort at the beginning of peeing and at the end.  If this is as bad as it gets, I'm satisfied.  Wish I'd had it done 5-years ago.

JD in Raleigh

Do you gave Original Medicare or Medicare Advantage?

thanks Steven
It was encouraging. I still have IC and started Kegel, hopefully it will go away soon. Otherwise I am fine.
What a sweet deal you got with Medicare:-) I probably should drop my employer's plan and get part B. What do you do about meds? Don't you need part D for drags? I don't recommend Medicare Advantage, it limits your choice of doctors and treatments.

Thanks again for visiting the forum, most guys dropped off after a month or so. We need to stay in touch to be aware of long-term consequences. I heard about men needed more surgeries years later because of formed scarring. I promise to come back regularly until alive and not senile.

Hi Sleepless. Great news! I am now getting IMMED alerts to posts! There are three parts to Medicare: A Hospitals, B Doctors, D Drugs. I'm enrolled in Medicare A through Social Security. For B (Doctors) I chose (I think) pland D (not to be confused with Part D - Drugs) with New Era Insurance. They pay direct to provider and have covered 100%. For Part D - drugs I use the AARP plan. I had Aetna for the first year but they jacked up rates. It's about $40/month. I came within $50 of my Donut hole bacause of Blood clot drug. The Holep has no pricey drug. I'm glad that New Era only raised rates a little, I'm told that if you switch Part B provider then prior conditions are excluded.
Unless your employer is paying 100% of your insurance, you will probably find going to a Supplemental plan to be cheaper - and you may not have a "prior condition" exclusion. Like the HoLep, I'm 100% satisfied with New Era.

Hey, I'm not going anywhere off the forum. This is one of the best - and most honest - ones I've been on. These are REAL cases about a SPECIFIC surgery. I know someone one said they were meeting with Dr. Das in Phillybut never heard from him again. BTW, I learned yesterdeay that Jefferson (where I had done) is the OLDEST Dept of Urogology in the country and it's a teaching hospital.

Keep up the Kegels. We're with you.

Great report JD! So glad you are healing up! I agree. I sort of wish I had done 5 years ago but I was only 64 and not on Medicare and I can't imagine the cost! (Now four years ago it would have been okay )

Wow, what adventure you had. Sure enough your 200cc beats mine 150. So Dr. didn't make new hole? Did you go backpacking yet?

thanks for prompt reply, let's stay in touch

Thanks Steve. Although I didn't have Medicare 5-years ago when I was 62 I would have still done it even if I had had to work past my 66th b'day. The cost at the Mayo was in the mid $30s and I've been asked to pay +-$2k which I did gladly. It amazes me that there are still guys getting TURPS, Green-Lite "specials" and full prostectomies. I'd hate to have a full prostate removal and find out there was cancer in there that's now floating around who knows where. I pee every couple of hours whether I need to or not. Did get Peyronies and hope it goes away but it doesn't obstruct or hinder the retrograde. JD

Hi SiS - Procedure was in July and starting in mid-September I backpacked and hiked for a month in Arizona and Utah. My last day out I hiked 16-miles along the Escalante River until I hopped over a snag and sank through a very wet sandbar up to where my prostate used to be. A bit hairy extricating myself as I didn't want to mimic the Saturday serials from when I was young nor have my group (an hour behind) see me in that predicament. Up until the trip I'd been hiking every weekend and started a week after the procedure although the 1st weekend was only a 6-miler. I say it not boastfully but to show what lack of limitation the procedure creates. Best in health, JD

Did you get Peyronies because of the surgery?

Probably. Never had it before. It is a mystery as I understand it to the medical establishment. Not happy but since I'm not taking photos and I'm only aware of it about 1% of the time, it's OK.

BTW, I neglected to mention before that my prostate was so big it had caused a fold in my bladder where a 1/3 of a liter of urine would stay trapped unless I catheterized it out. Nasties proliferated and infections occurred regularly. Having stuff like that just waiting to backflow into my kidneys was the final reason for me to have the HoLEP. JD

King Louis XVI had it, which prevented him having sex and children for years, but eventually he was successfully treated. Later he lost hid head, but it wasn't related. If they could treat it in 18th century, they can help you now. I guess some damage during the surgery could cause scaring. Anyway it seems you didn't have much choice.

I imagine Louie was a bit younger than me (back in 1743) and far more concerned about his legacy. It is definitely caused by scarring (probably from the HoLEP) but it only manifests by a slight change in the course of the river. Since my PD doesn't cause ED, I'm not going to give it a great deal of thought. A small price (very small price indeed) to pay for a vast improvement in lifestyle not to mention reduction in stress.

Last May, before the procedure I was in a single-wall, well-ventilated tent in southern NM. Attempting to self-cath twice a day in a tent with grit blowing 24-hours a day had a diminishing impact on the pleasure of my surroundings. While I still don't care for the grit, at least I don't have to worry about it being introduced to areas best left alone. Best, JD

Oh man, you have been through a lot.

I gave up backpacking many years ago but still go on daily hikes or snowshoeing trips. Physically I feel ok, but not sure how to deal with IC. I am ok when staying put but walking squeezes some out. Diaper's change on the trail is not an option.

Besides IC I am ok, doing Kegel, wearing pads, and thinking of going snowshoeing after X-mass if IC goes away