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

Hello, gentlemen, I just had my HOLEP done by Dr. Mitchell Humphreys at Mayo Phoenix, so thought I would post a few observations for the benefit of others who are sitting on the fence deciding whether or not to submit to surgery. I believe Dr. Humphreys spent a year learning the procedure from Dr. Lingeman in Indiana.

First, Dr. Humphreys and his entire staff are consummate professionals. By now, he has performed 600+ surgeries and counting, and stated that only 4/600 have required surgical follow-up. As he stated, they have a "protocol" for all pre- and post-surgical procedures, having had so many experiences with them.

I am 59 years old. I had retention, hesitation, urgency, frequency issues, with several bouts of prostatitis in the past few years. My surgery was on a Friday, and I had the Foley catheter in place until Sunday lunchtime when I was released. My post-op bleeding was a little more than average, but no issues really otherwise. I accepted pain meds Friday and Saturday, but have not needed any pain med whatsoever since. A week later, my urine is mostly clear, with an occasional drop or two at the end of the stream. The stream is unbelievable - race horse quality!! I initiate urination nearly instantly, empty completely every time. I don't even get up a night anymore if I stop drinking fluids by 8 pm or so. I do have occasional minor spasms in my urethra - but I suspect they are caused by Mr. Prostate issuing some post-op complaints. The quality of my life is improved already, just one week out!!

A couple of ideas mostly reiterating what others have said:

1. start taking stool softeners a few days prior to surgery, and pay attention to what you eat. Higher fiber and moderate to light amounts would probably be best. Plan a few meals of your very favorite foods after your release from the hospital - I had lost my appetite, but a after a few choice meals, it has returned with a vengeance.

2. after surgery you are instructed to drink large amounts of water, and by Saturday I was consuming probably 24 oz./hour in effort to help flush the bladder. Be sure to eat adequately to ensure you are taking in electrolytes and sodium sufficiently to avoid hyponatremia - low blood sodium. I had no appetite, and kept drinking water like crazy and had some dizziness and confusion that were probably the imbalance of water to sodium in my system - potentially a dangerous condition. If you are going to drink 4x the normal water, be sure to take in 4x the sodium as well!! (tortilla chips and salsa as regular snacks like the distance bicyclists consume work great!)

3. I think I have found a way to reduce the frequency and intensity of urethral spasms one week after surgery. The spasms occur when I am at the end of a urine stream, emptying my bladder of every drop. If I begin to slow the stream a bit and go ahead and stop urination prior to getting to that point each time, I experience no spasms during the urination, and minimize them afterward. Previously, those spasms would continue for an hour or more after urination, and were pretty uncomfortable. As I understand it, they will resolve on their own in the coming weeks.

4. Don't purchase the full absorbent underwear, get a package of "male incontinence pads." If you wear boxers, it would probably be a good idea to switch to briefs to keep the pads in place until you no longer need them.

5. When it comes time to remove the Foley catheter, ask the nurse if you can do it yourself. Go very slowly, and if it hangs up when you are removing it, twist gently to free the path. Take several seconds to remove the catheter, it's not a race!! My nurse pulled mine out in about 2 seconds, and I almost fell over with the discomfort.

6. If you are uncomfortable with the Foley catheter while it is still in, try changing your body position in the bed. For me, lying on my back resulted in a constant pressure from the Foley balloon, but if I lied on one side or the other with my knees bent, the pressure was decreased by quite a bit.

7. Follow directions and keep your attitude positive!! I kept repeating to myself "a day or so of misery and the rest of my life in bliss!" Even one week after surgery, I have zero regrets, and am amazed at how much better I feel. I sleep the entire night! I don't have to plan my day around trips to the urinal!

8. Lastly, pay attention to your body when you are healing. Especially that first 48 hours after release from the hospital, get a good book or the TV remote and just lay around. Movement of the prostate from even easy walking tended to keep the (minor) bleeding going, but I could stop my post-hospitalization bleeding every single time by sitting with my weight off of the prostate area. Don't sit in hard chairs with the pressure on your prostate. Sit in soft chairs in which you can lean back and take the pressure completely off of that area

Well said! It is a life changer.

Great advice - thanks for sharing. Am scheduled for 1May and am reading folks experience avidly. Stay well and Godspeed...cheers

Sir I am considering Holep next month. I have had PAE 9 months ago and unfortunately it didn't work for me because of my median lobe protrusion which became even bigger after the PAE procedure.
Where did you have your holep? which doctor
Have you had a median lobe protrusion?
Did you have the three lobes enucleate?
how good were the results so far?
Thank you
Regards

Sir I am considering Holep next month. I have had PAE 9 months ago and unfortunately it didn't work for me because of my median lobe protrusion which became even bigger after the PAE procedure.
Who is doing holep in India? If you know good doctor name?
Have you had a median lobe protrusion?
Did you have the three lobes enucleate?
how good were the results so far?
Thank you

Can't comment on your questions but had the Holium/Holep procedure two days ago. One night at Hospital. Virtually pain free. Not much control yet so Depends are in order. I had to self cath after loosing ability to urinate after open heart surgery in November. I had an enlarged prostate as well so I guess that was the perfect storm. I am hopeful that I will regain control over time. Patience is the by word here.

I had same surgery and I am glad I did, but I am using a great deal of incontinence pads and it seems I drip every time I get up from bed or from sitting. Hopefully that will go away. I am 10 days post surgery. The only regret is that I did not spend enough time understanding what to expect after surgery and it is IMPOSSIBLE to reach Dr Humphreys as he must be overworked at Mayo....Great Doctor but I would like better access

I had the HoLEP with Dr. Lingeman in Indianapolis three and a half months ago. For the first couple of weeks thereafter, I did leak a lot and had to change the pad several times a day. Now, I still wear a pad which I change only oncedaily, at night before bed. I leak a little sometimes, but not every day. Many days I don't leak at all. I still want the reassurance the pad provides but barely need it anymore. Maybe soon I will try to go without pads. I believe the degree and length of incontinence following HoLEP varies from one patient to the other, but I think it is quite common. Be patient and be thankful for the benefits this surgery provides. I am!

Do you still recommend Dr. Lingeman. I live in Texas,how many days before the operation I should consider going to Indianapolis?
Did any body consider TULIP (instead of HOLEP. Any place in US doing TULIP? I understand it is done extensively in Europe..

I had the HoLEP with Dr. Lingeman last December. I do definitely recommend Dr. Lingeman. He has performed over 2000 HoLEPs and in my case successfully. I have read many others besides me who praise his skills. I suggest arriving in Indianapolis one day before you're scheduled for the procedure and planning to leave for home the day after surgery. You probably should not drive home since you're not supposed to exert yourself for two weeks after surgery.
I'm not familiar with TULIP so can't comment on it.

I forgot that Dr.Lingeman wants to meet with his patient the day before surgery, so you should arrive in Indianapolis the day before you're scheduled to meet with him.

Thanks for your reply and advice. How old is Dr. Lingeman?

I don't know exactly, but I believe he is about 70, give or take a year or two. He appears to be healthy and vigorous, if you're concerned about his age.

Dr. JAMES E LINGEMAN Practice and experience

Dr. JAMES E LINGEMAN Practice and experience with patientDr. LINGEMAN graduated in 1974 since then is practicing in medical field for about 41 years. Since 1974 no malpractice has been reported for this physician. Dr. JAMES LINGEMAN is practicing in INDIANA CLINIC UROLOGY LLC with other 6 doctors. Doctor and his group mates are now practicing in INDIANA UNIVERSITY HEALTH INC, INDIANAPOLIS – IN and other hospitals lited here.

Medicare Assignment & Participation With Insurance Companies

Medicare is social insurance program in USA and Dr. JAMES LINGEMAN accepts Medicare medical insurance approved amounts as Payment in Full. If physician Dr. JAMES E LINGEMAN takes Medicare approved payments then 30 insurance companies under Medicare are accepted by Dr. LINGEMAN.

Just did my HOLEP w/ Doc Lingeman on May 1st this year. All is well and recovering nicely. Highly recommended, no nonsense skilled physician. Assistant Stephanie first class person and nurse. Get all details on web. Worth the trip to Indianapolis/Methodist Hospital. Best HOLEP Doc in the USA...

Some of you considering HOLEP may be wondering about the costs. I have Medicare plus Anthem coverage through my former employer the State of Virginia. The total billed cost for my HOLEP with Dr. Lingeman and associates was over $31,000. Medicare either wrote off or paid most of that. Anthem paid about $900 in remaining costs, and I paid...zero! Stephanie had told me I would probably not have to pay anything and she was right.