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

My latest PSA has gone down to .93 from 5. It has been almost two months since my surgery and suddenly i had an episode of hematuria today just once. Did you notice anything like that.

Yes , I believe it happened as a result of burned tissue sloughing off ,Like a scab coming loose from a wound. It happened on a day I decided to clean out my garage. It cleared up without any problems.
I would examine my urine through a glass beaker. The day I experienced hematuria there was a lot of scab like looking material in the sample.
1 . To monitor my output progress. It was common for me to experience an urgent need to urinate, yet I was only able to expell 110 ml. I was thrilled when my bladder began to break it's bad habits.
2. I would examine my Urine and monitor the Tissue and little threads of blood that were expelled. It can be quite surprising the amount that is expelled.
My PSA went from a high of 17 down to a 0.37, I believe.
All the best,
just me

I'd really value your opinions on my situation.

I'm 48. A few years ago in a routine screen my PSA was found to be high for my age (2.6) and my prostate was found to be enlarged during a DRE, but no action other than monitoring was deemed necessary.

In January this year I suddenly developed a high fever and was hospitalised for almost a week with severe prostatitis and acute urinary retention. When I eventually came home I was catheterised for about a month and placed on Tamsulosin (Flomax).

I'll spare many of the details of what has happened since and summarise it. I find the Flomax side effects almost unbearable - extreme fatigue, mood swings, serious depression. I dropped the dose to every other day which helped but was still tough to cope with on the "tablet" days. In the last week my a Doctor prescribed me low dose viagra as an alternative, but within days I had severe muscles pain and could not continue. Unfortunately I do have a long history of not tolerating prescription drugs well.

Some weeks ago I had a barrage of tests including MRI and cystoscopy. The MRI showed no sign of cancer and a prostate volume of 56cc. The cystoscopy showed narrowing of the urethra and at the time my urologist indicated than surgery seemed a reasonable prospect. He scheduled urodynamic testing for few weeks later, but a week before the tests I started showing signs of prostatitis and retention again and was forced to go back onto Flomax daily.

When I did the urodynamic tests, they came up as within normal parameters. I think this surprised all of us, including the urologist, who then explained that he didn't feel surgery was worth the risk given that I could urinate "normally". When I asked if that was simply because of the Flomax, his reply was "I don't think that would make much of a difference". Well, why the hell am I taking it then?

I can't tolerate the medication in the long term, but I clearly can't do nothing either. I urinate 12-15 times a day including 2-3 at night, and have episodes of pain like I've been kicked in the jewels. From a quality of life standpoint, I'd rather take my chances with surgery than put up with the drug side effects. The trick, of course, will be to get the surgeon on side. I live in Sydney, Australia, so I think there are only two people here who do it.

So I guess my question is, have I missed anything else I could be trying, or am I justified in feeling like surgery is a worthwhile risk? I know I'm young and my prostate isn't enormous, so I understand the urologist's hesitation, but the prospect of trying to cope as I am for potentially several years is pretty hard to bear.

Thanks for reading, I really did try to keep this short!

I would assume that he gave you long term antibiotics since that is the way to treat prostatitis. Sometimes you have to take it for a month or longer.

No, he specifically refused to do that, even when we asked the same question. His argument was that I would become antibiotic resistant.

I should add, I was on IV antibiotics in hospital and oral antibiotics for a few weeks afterwards, but that's all.

I am not an urologist but when my PSA started going up, he recommended to use vibramycin for a month. Old tetracycline antibiotic. It didn't help me but that is what he told me was for chronic prostatis

Hey Steve
I just had holep surgery from dr das
Dude is a rockstar and I think I'm doing well
A little blood in the pee but I was expecting that
How are you doing and do you ever follow up or have issues
I was getting chronic uti and was hospitalized three times this year
The butchers in Trenton nj wanted to do Turps on me
Thank god I found dr das

Hey Steve in philly and sleepless
I just had holep this month from dr das
So far I am doing well
A bit of blood in the urine but I was expecting that for a while
I went to three urologists in nj and ended up being hospitalized twice this year with severe kidney infections and sepsis
Almost died at 50
The butchers here in Trenton nj pushed Turps on me
After reading about holep I found dr das
Dude is a rockstar and has
I think
Changed my life for the better
I still am not happy about retro but am glad to be in much better health and peeing like a race horse
Hope we all have great success
Dr das was awesome in every way

Lindsay Baker - I had urinary retention issues, high PSA, without an abnormally large prostate. I had my HoLEP at age 56. The problem was obstruction in the prostate urethra. For me the surgery fixed the problem and I have no regrets. You can scroll back and see my posts as "Big500" that outline my experience. Good luck. Big500

I had planned to go to Mayo Clinic in Phoenix Az for the HoLep procedure for my BPH. However I live about 275 miles away and was told that two trips would be required as they would not accept my local urologists reports to either qualify or disqualify me for the operation. Then I began thinking about ongoing post-op care. Making the long trip was simply not practical. Fortunately I found a wonderful local urology surgeon, Dr. Pedram Ilbeigi in Rancho Mirage, CA who also does HoLep. However upon examination my prostate was found to be in excess of 100 grams (which, as it turned out, would put me beyond Mayo Clinic's max of 100 grams) and I had 40 bladder stones that needed to be removed. If I chose HoLep the operation would have to be "staged" (two operations as the prostate being so large) and the stones would require yet another operation. We decided on Da Vinci Robotics and dealt with both issues at the same time (and, as it turned, with a hernia repair thrown in). The operation was December 8 and it's now the 14th. I was 2 days in Rancho Mirage's Eisenhower Hospital (longer length of stay had something to do with my age - 76), both the operation and stay in hospital were exemplary. Virtually no bleeding, and minimal pain. The gas they use to bloat the abdomen was/is the biggest culprit. Catheter should come out tomorrow after one week.

I had HOLEP with Dr. Lingeman in Dec., 2014. What is a little confusing about the last post before mine from the patient who had surgery in Rancho Mirage, CA is that he states that his prostate size of over 100 grams would cause him to have two surgeries. I was always under the impression that the size of the prostate is not a factor in having HOLEP and that someone with a prostate of 300-400 grams, for example, could have one surgery to remove the excess prostate material. This is one of the big advantages of HOLEP over TURP surgery. My prostate was 163 grams and I had the one surgery where approximately 130 grams of tissue was removed. Jack.

Perhaps the difference is in either a complete prostate removal and a partial?
I only know what I was told for complete removal (which I had): Mayo Clinic - 100 gram max - using HoLep. My local surgeon quoted 60 grams at a time for complete removal of my 100+ gram prostate - using HoLep.

Here is my holep experience : up to April '16 I had mild LUTS, IPSS score about 12, peeing 2 to 3 times a night quite slow. Probably chronic non-bacterial prostatitis. Suddenly this became IPPS 19 or so, peeing 8 to 12 times a night, never feeling empty. Probably acute bacterial prostatitis though urine tested clear (not a cultured test, just simple). I didn't want flowmax (eyes ! - wanted to avoid IFIS for later cataract surgery, if ever needed) and wasn't offered antibiotics. Was talked out of 5-ARIs (inappropriate for a 49 year old). PSA was 17, no cancer (MRI+biopsy; NB prostate only 22cc), retested 4 days later PSA=10; LUTS becoming less acute. Decided to bite bullet and solve the longer-term moderate LUTS with a HOLEP; cystoscopy showed prostate bulging up on bladder base so urolift might not resolve frequency issue. 2 weeks pee-pain, then 1 week bleeding, culminating in 2 big clots then clear (from then, flow rate improvements were big). +7 weeks on from HOLEP, at first ejaculation, no sensation. By +14 weeks, most sensation had returned; I never got it all back, never mind. Retrograde, of course. Flow rate steady since then, over 30ml/second, very good; now at +6 months and up to now I was still getting up to pee once per night, at +6 hours after going to bed. Measuring pee occasionally, it was 250 to 300 cc. My uro, same age, told me he pees 750 cc. In recent days I have made a HUGE effort not to pee when I felt like I really needed to, and hit a new high daytime yesterday of 500 ml. Last night I went to bed at 12pm, woke wanting to pee at 6am but ignored, feeling resided, it is now 4pm the next day (+16 hours !!) and I've drunk plenty yet still did not feel the need to pee (slight feeling that I needed to had gone away) - however did so just in case I was pushing it too far, and voided 560ml. Next time I will hold on longer. Clearly a bladder can take a lot more than we realise (NB I am only 50, and not fearful of making it too flaccid etc). Am hopeful of working up to using my full 750 ml or so - just needs willpower because it is clear that even after HOLEP it was STILL for 6 months, telling me I needed to pee too soon. Needed recalibration !

NB my post-HOLEP PSA as measured at 2 months and at 4 months, both times was 0.66, having been 17 and then 10 pre-HOLEP. Of my original 22cc prostate, 10 cc (estimated) remains, 6 cc having been removed as intact tissue and 6 cc (estimated) ablated by the laser. Just shows that often even a PSA 10, can be due to inflammation or prostatitis, and not due to cancer.

Hi Jonal,
I am 52 yrs old, Ihave just been told to use catheter 4 times daily.....currently waiting for laser surgery. I am concerned about retro ejaculation, I know this is silly but that's how I feel....how is your sex life?
I am not 100% sure whether I am ready for laser procedure and am thinking of just making do with the catheter to empty my bladder.
Any advice from other patients would really be appreciated, thank you.
Kind regards,
Chris