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

Jack here

Hi

I had HOLEP on Dec. 12,2014 with Dr. Lingeman in Indianapolis and it has been a wonderful experience. The only reason I had to have the surgery was because my bladder was retaining too much fluid and it was either have HOLEP or catherize yself three times a day. Even with the HOLEP my urologist who referred me to Dr. Lingeman wasn't sure it would work since I had waited so many years. In 2002 my retainage using a bladder scan was 35ml. It rose over the next 12 years to 800ml in May, 2014. Well, I saw the urologist today for my first appointment after my surgery 10 weeks ago and had a bladder scan. It showed only 40ml of fluid retained. I was floored as I didn't know if the surgery would solve the problem due to my negligence in waiting so many years. I stopped wearing pads after 6-7 weeks and things have been great. For any gentlemen on the fence about doing this, please go to an excellent HOLEP surgeon such as Dr. Lingeman and have it done. For me, it was much easier than even having a cystoscope exam, which I always dreaded. Just an overall great experience for me in Indianapolis. I took Just Me's advice and waited six weeks to try sex. The first four times or so it was retrograde but the next few times some fluid came out. Not very much, though. From other people's experience, does anyone know if this was normal ejaculatory fluid or something else and should I still expect to have complete retrograde ejaculation later on? I would say the orgasms are not as good as before but I'm not complaining as losing my kidneys or catherizing myself everyday would have been far worse. They might even get better over time. They really are only a little worse than before so it's not a big deal at all Good luck to others considering having HOLEP. As I've mentioned before, it's too bad all urologists do not recommend this to their patients whose prostate is too large to have a TURP even if it means referring their patient to a urologist who performs it.

Jack

Now 4 weeks post-op.  Not much change.  Seem to be getting slow steady improvemnt with stress UI.  I experience burning in penile urethra at end of unination.  No blood.  I am 57 and had acute retention 1 week prior to HoLEP, but I had the "symptoms" for 10 years or so.  Prostate was never called out as abnormally large through rectal exams.  PSA levels elevated into the 5 range over the past couple years (biopsy in 2012 negative).  Dr indicated that it was the specific way the prostate was growing that put the "squeeze" on me.  Since 2009 I have been a casual road bicyclist getting in about 80-100 miles per week. 

I just had my first visit with Dr . A. Das at Thomas Jefferson Hospital in Philadelphia today about having HOLEP for my BPH. It was a very good experience. He appears to really care. While there he ordered a series of tests including, flow rate, urine retention and some tests to rule out bladder problems. It was great to get things moving quickly. I'll be having the Holep surgery early April at John Hopkins. I'll let you know how it goes. Thanks to this forum I found Dr. Das. He has written about the procedure extensively and was already in New Zealand when Dr. Lingeman came to learn this procedure. Why the Kegels? Steve

Hi Don! THat's great! He really does care and doesn't rush! So he does at Hopkins too? I keep trying to explain to others that Dr. Das actually taught Dr. Lingerman but they don't believe me . Oh well.
The Kegels are to train yiur bladder not to be incontinent when you stand up. Like most of the others found, yiu will not need to get up to pee at night but when you do stand up yiu will need to. This goes on for may 3 months. Reason for the pads. You can try to do the kegels without help but I couldn't and went to two biofeedback sessions (with Darlene in Dr. Das' dept at Jeff) and that helped. (Yes, Medicare covers it.). In fact when I met with Dr. D in December for my Annual, he agreed that he should probably recommend two biofeedback sessions to ALL his HoLep patients.
Before yiu have the surgey pick up a pack of 40 Generic (I use CVS) pads. You'll want them when catheter is removed. I actually never had an "accident" but they were there just in case. And they are actually comfortable.

The flow test is a regular one. You just urinate into a funnel.
Anyway, I'm glad you were confident in Dr. Das. His disposition is treally calming.
Let us know the date of surgery when you know it. We're all here to help yiu.
Steve

Sorry for the confusion, I should have stated that I'm having the HOLEP procedure at Thomas Jefferson in Philadelphia not John Hopkins. I'm scheduled for the HOLEP on April 13 to accommodate my schedule.
Don

Thanks for confirming Don. I had great care there. Keep us updated. I'd be happy to talk with you on phone if yiu need anything (don't post phone # here though)

Now 4 weeks post-op. Not much change. Seem to be getting slow steady improvemnt with stress UI. I experience burning in penile urethra at end of unination. No blood. I am 57 and had acute retention 1 week prior to HoLEP, but I had the "symptoms" for 10 years or so. Prostate was never called out as abnormally large through rectal exams. PSA levels elevated into the 5 range over the past couple years (biopsy in 2012 negative). Dr indicated that it was the specific way the prostate was growing that put the "squeeze" on me. Since 2009 I have been a casual road bicyclist getting in about 80-100 miles per week. big500

Hi Jack,
The first few times I had a normal ejaculation. The fluid seemed to be a lot thinner in consistency though. Now it is strictly retrograde,with no fluid. My orgasm is quite satisfactory at the present time. Im glad you went with Dr Lingeman. I had to cath from the first of July to the last of october. 70 times I went into acute retention and could not go at all. Life is so much better now.Just me

Hi big500 you sound a lot like me. the incontinence will get better and the burning will stop. The burning didnt start until a few weeks after surgery. I thought it was a result of having a urethrotomy but Dr Lingemans nurse said The burning radiates from the prostate to the penis. Nerves are strange. A injury can occur in one part of the body and manifest itself in a different part. Holep is an intentional injury that bring very good results in a short period of time. all the best just me

Now 6 weeks post-op.  Not much UI now when walking - this is an improvement.  UI is mostly when bending, lifting, coughing etc.  Still have a burn at end of most uninations

Thanks for update Bill. Are you sleeping through the night? (I hope so). Bet that didn't happen before surgery. I didn't have burn that far from surgery but we are all different. Keep doing those Kegels. !!

Jack here
I had HOLEP 13 weeks ago and it really was a great experience. For some reason, a week ago I started having strong frequency problems with just a small amount of urine coming out upon urination. Also, I started having incontinence problems that were much worse than the first few weeks after my surgery. I'm being checked for a urinary infection now but I'm fairly sure it will be negative as I have never had a UTI in adult life after having many urine cultures done. So, I'm wondering if anyone has any ideas what could all of a sudden be causing this. Would a urethral stricture cause these symptoms? I did have a partial urethrotomy done by the surgeon so that my opening could accommodate the instruments used during the surgery.
Thanks for any ideas. Jack.

Hi Jack: I went right to the expert (well I consider him the expert on HoLep): Dr. Das who did my surgery. He's really responsive and sent this reply - which I'm copying verbatim. (This is one of the great things about this Steadyhealth newsgroup. TExt below my signature is Dr. Das' words.
Steve

​Steve,




There is a variety of reasons why some men develop frequency 3 months post HoLEP. One of the reasons may be a urethral stricture, but others such as overactivity of the bladder, inflammatory change in the prostate, and accomodation of the bladder post HoLEP may contribute to this person's symptoms. Patients who have some overactivity of the bladder prior to surgery will have irritative urinary symptoms at varius periods during their first six months post HoLEP. However, in this person's scenario, more information regarding his urinary issues such as flow of urine, residual volume, night-time urination, burning, etc would be needed to make a full assessment. I would suggest for this person to be evaluated by his urologist to find the cause of his urinary symptoms and to decide on strategy to relieve these symptoms.





I hope this helps.

Jack
Steve, thank you very much for presenting this to Dr. Das. I really appreciate it. My urine culture came back and it was positive for a UTI. My kidney bun levels are up quite a bit so I'm wondering if I might also have a kidney infection. Hopefully, not. My local urologist, who was trained in the HOLEP procedure prescribed Ampicillin, 500mg, four times a day for five days. I haven't seen him, yet, as this was all done over the phone with his nurse. I developed a fever and malaise the past two days so I'm a little concerned. The Ampicillin has greatly cut down on the frequency but I'm not emptying my bladder and am retaining fluids as I'm taking in a lot more than I'm putting out. If this doesn't improve by Monday, I will call my urologist to see him. One of the things I was concerned about was the possibility of a stricture. From what I have read, a stricture is very difficult to fix. I think the percentage was only 25% for a success rate and some of the treatments can be pretty risky so I'm hoping that is not the case. Again, thank you very much for going the mile for me with Dr. Das.
Jack.

Jack. Please remind me who your Holep surgeon was and where? Was it your local urologist who performed the surgery?
I'm afraid I'm not that versed in medical conditions - in fact, unlike most others here, I went into the surgery based on recommendation of my dentist (who helped me find Dr. Das) and the confidence, and empathy, that Dr. Das showed. He's VERY calming. So I just went with it. I no longer wanted to get up 4-5 times a night and take Flomax and Avodart for rest of life. Now I sleep and don't need the drugs and (as I've said here before) I get an erection but - for other , non medical, reasons I don't have an active sex life. But for me it was about the sleeping and frequency and blockage.

Glad I could get some kind of answer for you. Please report back on what occurs Monday.

Steve