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

I had the HoLEP with Dr. Lingeman 5/4/16, and wholeheartedly recommend both Dr. Lingeman and the procedure. I also live in Texas. After he removed about 90g of my prostate, it feels like my life has changed. Recovery was a breeze. I did have issues with urgency for a few months, but VESIcare took care of that. I'm now off of the VESIcare and back to my pre BPH days. The only side effect left is the RE, but then I had that before caused by prescriptions.

I have gained so much knowledge from this extensive thread that it's only fair for me to add my own Holep experience.

I'm 74 and had been followed by a urologist for a number of years and started Flomax about 5 years ago. I had a HUGE prostate, MRI measured at 168 grams, but I generally managed life despite most of the symptoms of BPH. What altered my treatment plan radically was an emergency trip to the ER over the holidays for full retention -- a very painful experience. Catheter put in but a few days later I had another retention emergency when blood clots in the bladder covered the drain holes. Luckily I was seen by Dr. Andrew Wright, who did a cystoscopy to check for bladder cancer. As he was doing this, he was also recommending that I consider a Holep procedure. He does this procedure, but feels 140 grams is his current limit, and referred me to his mentor, Dr Joel Funk at Banner Medical Center South here in Tucson. Apparently Dr Funk is one of only a handful of Holep surgeons who do surgeries on prostates my size (they can even be bigger!!). As I understand it, the only other surgeon in Arizona to tackle prostates of this size is at the Mayo Clinic in Scottsdale.

I saw Dr. Funk in February and his earliest available surgery date was May 31st, which I took. In the interim, at his recommendation, I had 5 sessions at the Pelvic Floor Laboratory, learning with biofeedback how to control and strengthen my sphincters. I made progress.

So the big day was only 10 days ago. It was outpatient and I went home with a catheter. The next morning I went back and the nurse removed it after inserting fluid into the bladder. Then I had to demo I could urinate. Success!! Rather than over detail my recovery, let me say I experienced many of the aftereffects written here, so I certainly felt normal. First few days had plenty of blood clots, and blood in the urine was common for a week. I had control, but certainly had a small spasm or two. I used men's guards until two days ago, and they were great. I used a kind with reusable elastic bands to hold them in place, and didn't wear anything else under my clothes.

I decided to stop using the guards "cold turkey," as I felt I could take care of the post-urination dribbling with a short use of toilet paper. It seems to work fine. I suppose I could still have an accident, and I suppose blood in the urine could return, but so far things are going great. I drink a lot of water.

I see Dr. Funk on Thursday, and until then, I'm not doing anything even close to strenuous (and I'm normally quite active) and I haven't resumed my sex life. I'm expecting a green light for both on Thursday.

I forgot to mention Dr. Funk took out 148 grams of the 168. It was sent out for pathology.

Thanks to all who have contributed to this great thread.

Bruce

i there,
I would like to share my experience with Urolift and Holep. My prostate was 75 ml and medications were not helping. I researched Urolift and went to Georgetown University in DC, the only place in the area which does the procedure. Dr. Bandi suggested that although I am a candidate for Urolift, I should strongly consider a Holep. He recommends Urolift only in patient with small and medium size glands (upto 50-60cc). I decided to try Urolift. I was a 5 minute office procedure. It worked better than medications but I wasn't satisfied. Had a holep later and wow, what a remarkable improvement. Should have listened to my doctor!!

I had surgery with Dr. Bandi in 2015 and had a great experience. He was the fifth urologist I saw. Everyone in the community wanted to do a Greenlight laser. I had heard that Greenlight laser can cause a lot of irritative symptoms as the bladder gets some collateral damage and the reoperation rate is as high as 30%. I asked Dr. Bandi why no one would offer a TURP or Holep. He said that both procedures require overnight stay to observe for bleeding as a significant amount of prostate is removed. Most doctors in the community do not want to admit patients as they have to evaluate and discharge them next day, which their schedule doesnt permit. They would rather be in office seeing patients and making money. In addition, some doctors make more facility fee if they do the procedure in a surgery center where they have an ownership interest. He also mentioned that HOLEP has a long learning curve (20cases) and require more equipment, most surgeons give up during their learning curve. He learned holep from Dr. Lingeman himself. I am glad that I didnt have to go to Indianapolis and pay my 20% co-pay to get the procedure as that would have been thousands of dollars. I just paid my $100 deductible. I strongly recommend him for any prostate procedure (robotic prostatectomy or holep) in the Washington Dc area.

I had my Holep surgery Few months ago with Dr. Bandi at Georgetown University Hospital in Washington DC. It was a great experience from the beginning. I have had Greenlight laser done twice and continued to have urinary symptoms. I am a doctor myself and found this doctor through my friends. The doctor was very thorough and professional and explained all possibilities at the first visit. My PSA was 15 and I had 6 prior biosies. My local doctor wanted to do another biopsy. Dr. Bandi performed a MRI, prostate ultrasound and bladder function study. To my surprise I had a very large prostate (80cc on ultrasound) even after Greenlight surgery. He didn't seem surprised and mentioned that the Greenlight procedure doesn't remove as much prostate as holep or TURP. He was confident my PSA elevation was from BPH And didn't recommend biopsy as MRI was negative. I stayed overnight after the procedure and have been peeing like a horse since then. Had some minor leakage concerns for 1-2 weeks, all gone now. No sexual issues. PSA is down to 1 !!! Highly recommended this procedure for anyone with BPH. Should have done it ten years ago.

I know of a person who has had hole surgery and after 4 years normal ejaculation returned. Is this quite common

Follow up to previous post. Saw Dr. Funk today for the 15 day follow up. Excellent results and pathology negative. Retention after urination cut by 70%. Control is quite good. Yesterday was able to retain by choice my largest amount of urine yet without a problem. Urinated 475 ml after many hours. Still have occasional very minor leakage, which both the doctor and posters on this thread say will keep improving over time. A very small coloring (blood) has reoccured, but that is also common. All in all, a very satisfied customer. Won't see the doctor again until October.

Trebor: Did Dr N Miller (at Vanderbilt Hosp. in Nashville) do you HoLep procedure?

Hello: I am new to this site and looking to learn more about HoLEP. Question: I live in Florida. Does anyone know if there are any EXPERIENCED HoLEP surgeons in the S.E. USA? Thanks

You can contact Dr. Dora in Tampa.

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I believe Total Prostatectomy is considered major surgery with a lot more potential side effects including bleeding. Also, I believe you have to wear a catheter for quite a few days. I have had HOLEP surgery and I don't believe very many people would opt to have a Total Prostatectomy over a HOLEP for an enlarged prostate. If you are concerned about coming down with cancer at a later date, I can understand your thinking, but, I wouldn't agree with it. You would certainly want to be sure, if you had the Prostatectomy, that you didn't have cancer that had escaped from the prostate itself to your lymph glands, for example. I would consider doing an extensive amount of research before having the major surgery. All the best.