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

just me,

 

Good to hear of your continued progress.

 

The stress incontinence may have been something that is a general experience with this type of surgery when in an occupation that requires heavy lifting.

 

 

I am at day 74 post op, and my pain is still ongoing although it is more on a scale of 3 out of 10 rather than 6 out of 10.

 

I was wrong concerning the urine culture, apparently the lab does it routinely. I am now on my 4th urine test with a 5th to come in about 3 weeks time. The 1st test 9 days post op showed no culture growth with only 15 pus/white cells, so I was right not to take an antibiotic. The 2nd showed no culture growth but almost 16,000 pus/white cells. Apparently the norm is up to a maximum of 50 pus/white cells. The 3rd test showed an infection plus the same amount of pus cells. I completed a 7 day course of antibiotics and the 4th showed virtually no culture but still about 16000 pus cells.

 

The GP suggested I could take a long term antibiotic but was not too convincing that it would help. I decided not to go with the antibiotic and monitor the level of the pus cells at approximately monthly intervals, trusting that my body's systems will rectify matters in time. My reasoning for this decision is because I found a possible explanation concerning the increased pus cells after some searching on the Net. Apparently there can be a significant rise of pus cells for months after prostate surgery.

 

From my own limited knowledge of physiology I know that an area of the body that has been subjected to surgery/ or injury is flooded by white cells that are needed to heal, repair and sometimes re-shape the area. This would also be the case in the trauma of HOLEP. Due to this process masses of white cells and macrophages die off as they go about their work.  I would therefore expect that both your urine samples would have shown the same higher level of pus/white cells.

 

The problem is that the doctors don't know if it is a response to an infection or the above process. I expect that there will be more sophisticated tests that would be able to differentiate between the two, but then this is more costly and time consuming, and they can just adopt a generalist approach and try whacking it with an antibiotic to see what happens.

 

This theory does not of course explain my continuing pain, but there again we possibly heal at different rates.

 

Perhaps hamzamale you should check if they are treating the evidence of an actual cultured infection, or a high level of pus cells. For example, I received a phone call from a nurse at the surgery simply relaying that I had to undergo another course of antibiotics. It wasn't until i drilled down that I discovered that this was in response to the level of pus cells in my urine and not to any evidence of a cultured infection.

Jonal ,

  I appreciate the fact you are involved with your situation. It is obvious you have done your research . For that I commend you.

  My Prostate is the second major health issue I`ve dealt with in the last 3 years. With each one, I researched all I could find about 

them .  We are not  Drs, but, at times it seems we are well on our way to becoming one! 

  I would assume this situation you are dealing with  has kept a portion of the enucleated surface raw for an extended period of

time which is why you are still experiencing pain.  You stated it was at a 3. Was it ever higher than that? How long did it last after

urinating?

  I also agree with you, concerning my situation,  I need to keep building up the pelvic floor muscles in order to withstand the stress

they are under when ever I pick up an object or bend over, both of which I do a lot.

   Thank  you for your input and encouragement .

   I continue  hoping the best for you.

   just me 

    

Greetings I'm JUST joinging this group though I had my HOELP surgery the Friday  before Christmas - so I'm about 33 days now. I'm 68 year old male. I was on Flomax for about 8 years and my prostate was getting larger. My dentist (really!) told me about HOLEP (we were discussing pain issues after root canal!) and recomended the surgeon. The surgery was a breeze (heck I was sleepng) and because of the holiday - and my still having blood in my urine - the catheter was in for 10 days. A relief when removed. I had some pain for a few days. Then they found an e coli infection and after a week of antibiotic that was gone. I now sleep through the night - used to be up 2-3 times. But - as with the rest of you - I have VERY fast urges and barely make it to a bathroon. Have not needed special underpants YET (but guess I was lucky each time). It only happens when I stand up! (Laying or sitting - like I am now at the PC and I have no urge. But if I stand up...... (oh boy!).This is the real major annoyance. I have appt with surgeon again tomorrow to discuss this and he mentioned the kegel exercises. I googled them today but still not sure how to find the sphincter nerve. Also, I used to have problem urinating until I "passed gas". Now it the reverse. I urinate and they must pass gas.

 

I get blood every few days but reading recent posts here it looks like that is still normal. Sure hope the urges stop soon. Not fun if at the supermarket and only one rest room and someone is in it. Are the rest of you wearing special underwear? Do they really work? (I mean in case you HAVE to go?). I'm subscribed to this topic so will continue the discussion with you.

 

 

 

 

Hi just me,

I thank you too for your encouragement.

 

I really believe you are getting there.  It is just a matter of time and repeated pelvic floor exercises.  I will really have to get on with them again.  I stopped because I thought they may have been contributing to the ongoing pain.  My reasoning being that there is a belief in medical circles that tension in that area can result in pain which can be relieved by relaxation or certain muscle relaxant drugs, and even anti depressants.

 

Re the pelvic floor exercises, I believe they are a longer term proposition, because I know from my wife's experience after surgery that the gains are slow.  They are probably more effective pre surgery, as in my brother-in-laws case.  So hang in there.  Some say it is a lifetime commitment if we want to have good control as we age, anyway.  Although it should be remembered that men don't have the same pressure in that area compared to women who have had children.

 

The pain I had from the outset, and at the end of urination was quite teeth clenching.  I would say about 6 or 7 out of 10, but every-bodies pain threshold can be different.  This pain completely subsided after about 2 minutes, but then I was left with a mild perineal ache and discomfort which would last for 2-3 hours.  In the last week or so the post voiding pain has now reduced to about a level of between 2-3 and the perineal discomfort subsides in about an hour.

 

When I took the ibuprofen the pain was virtually gone, but the over 60's should not take Ibuprofen for too long, so I stopped it and the pain returned.  I commenced low dose aspirin last night as I feel more comfortable with that in the longer term, although I think I took aspirin too soon after the HOLEP which probably contributed to the longer period of bleeding.  I can tolerate the pain, so the main reason I decided to take an anti-inflammatory was just that, ie to help reduce possible inflammation.

 

I am also now drinking cranberry juice, so that may help.  I prefer natural cures if possible, because there is usually some pay back with drugs.  I put aspirin into this latter category, because it was originally derived from tree bark.  Although I know you have to be prudent with aspirin.

 

Jonal

Hi SteveinPhiladelphia,

 

You seem to be doing quite well at 33days post HOLEP.

 

Some have shorter bleeding time, others longer.  I was in the latter category.

 

I am surprised you had a catheter in for 10 days.  It usually comes out the next day.  Unfortunately catheters breed infection hence your outcome.  

 

As you have already been advised, Kegel exercises are a must.  Google pelvic floor exercises for men and you will find a number of sites that provide good advice.  The procedure is like urinating then stopping yourself in midstream.

 

You may also want to try bladder re-training.  Again Google this for many sites with advice.

 

I think there is a gravity component with the bladder sphincter hence the urge when you stand up.  The 2 sets of exercises should help.

 

I have never had to wear pads, others may give advice on this.

 

Good luck.

 

jonal

 

 

 

 

Okay, met with the surgeon today. Took a flow test which showed good results. There was some blood but he said it will stop eventually - as I saw from others. Did an ultra sound and showed I am emptying. The issue now is urgency. He said there are some meds but they cause constipation - which is another issue I'm dealing with in my health issues spectrum. He said there us a new drug that is "supposed to be good" and gave me two weeks worth (one a day). It is Myrbetriq. I googled it found it is expensive. Over $200 (WITH a coupon!) for 30 days. Seems to have only 2 reviews. One liked it and other didn't. One person mentioned a much cheaper - older - drug Oxybutynin. Seems to have some side effects but mostly dry mouth. Anyway, sharing all this with you guys! I go back in 6 weeks.

 

He also mentioned the excercises but I'm still not sure I understand them. If any of you have a simple explanation, please share. Seems you are trying to squeeze the muscle you use when you try to stop urinating. But I can't stop now. Since HOLEP , it just flows out FAST! <g>

 

Anyway, thought I'd share update.

 

SteveinPhiladelphia,

 

You don't actually stop yourself when urinating, it is just the same action.    Simply contract and pull up the muscle/area between your penis and anus.  Pull up and release rapidly eg 4 times x 10 repetitions, and gradually build up the times and repetitions as your pelvic floor muscles strengthen.  You can also intersperse this with pulling up and holding up for as long a count as you can.  Repeat this as many times as possible as your muscles get stronger.  Aim for doing the exercises frequently throughout the day eg every hour.  You can do this whilst standing, sitting or even lying in bed. 

 

I hope this makes sense to you.

I think so . Will try. I didn't think you could do this standing up. They say usually on floor.

BTW, someone - you? - asked why catheter was in so long. Maybe I forgot to explain. Surgury was Friday before Christmas. Most places closed Monday Christmas Eve day and Christmas so schedule was for Wednesday (5 days from surgery. But Monday I got up and fainted and fell and had to go to ER and spent Christmas Eve and Day as inpatient. Because of there being blood in urine they moved from Wednesday to the next Monday - NY Eve. THAT's when it came out.

Hi Jonal, 

  I agree with drinking cranberry juice. I`ve been drinking a lot of it myself.  I also would admit the pain was teeth clenching but it was not that high on the pain scale for me. I have been dealing with sciatica recently so the pain while urinating didnt seem as bad compared to that.  It was painful but only for a short time and probably at a 4-5 when it was at it`s worst.

    I was given Pyridium at the hospital to use for pain while the catheter was in.  I had used it both times I had a catheter prior to surgery. It did help ,and I had some left over. I would take  a pill and it did help. It does turn the urine a bright orange color and it does stain . I do believe it helped me some. 

I do hope this ends for you soon.

just me

Hi SteveinPhiladelphis,

   I can relate to you with the urge incontinence. On a recent road trip, I pulled into a gas station . I was feeling fine ,but as soon as

I stood up and got out of the car, It hit!  I thought I could make it to the restroom ,but after 2 steps I knew I couldn`t.  I  carry a

urinal in the car for just such emergencies. I couldn`t  even get to it in time.  Fortunately I was wearing a pad, male guard , what

ever you want to call it.  I could do nothing but empty the entire contents of my bladder . I absorbed everything! I did not have to

change my clothes .

 I recommend the pads over the brief style . they are more comfortable and absorbent enough to handle any emergency .  The

brief style will hold more but I have never needed any more than the pad.  The briefs will bunch up between your legs and in time it

will feel as though you are sitting with a large rope in your crotch. For added comfort , there is a material that absorbs the moisture

enough to keep the skin dry.  If you are concerned about incontinence It is always better to be safe than sorry! We get them on

sale at the drug store for about 7-8 dollars for 52. Pretty cheap insurance.

 I would encourage you to try try to work your way through the urge incontinence without the drugs.   They have side effects, and

are expensive.  I managed to go without them and I have a rather strenuous  job that I had to return to with only 2 weeks off from

work.  Jonal and I share a common belief that natural is best .  That belief has served me well so far. I wore the pads and changed

the at each break with no problems. 

  Where did you you have you surgery done?  What Dr did you have ?   

just me

 

Thanks Just me. I might try to new drug samples and see for a week. I heard about the pads but wasn't sure they would absorb enought but sounds like they do. Do you wear to work and out all the time and just change when you have an "accident"? Can you tell me the brand and what drugchain you got yours at. Price seemed low to what saw on internet search. Sounds like you got the right kind and I'd appreciate the info.

I had surgery done in POhiladelphia at Jefferson by Dr. Akhil Das - really nice guy. I may have mentioned earlier but I heard about the HoLep priocedure from my dentist - who had to do self catheterization afor a few weeks. So he didn't have the incontinence issue. He now my "HoLep buddy"! ;-)

Hi SteveinPhiledelphia.

The pads do a great job. I wear them all the time as I have stress incontinence. I will leak small amounts of urine  over a long

period of time. This will occur while I am working ,bending stooping picking up heavy objects ,ect.  I have had 4 or 5 big accidents

 right after my surgery but none in the last 3 weeks.  The pads contained every accident . Make sure you wear a snug fitting  pair of

briefs to keep the pad close to your body so nothing will leak past the pad.  Just be sure to change it as soon as

possible after an accident.  I purchase them from Walgreens drug store, They are named Certainty .

  

  I had to cath myself twice a day from July 5 to Oct 22.  During that time I had to cath

 myself 70 additional times due to the fact I was in acute retention , in other words it was impossible for me to urinate I had

completely shut down.

 

I was not incontinent prior to surgery but I experienced it after surgery.  Although it is inconvenient to be incontinent, it is terrible

to be in

acute retention. It is painful and very stressful. It causes loss of quality sleep and is disruptive to normal; life in general.  If this is

as good as I will ever be, I do not regret my surgery. My life is so much better than it was prior to surgery.

One thing I have noticed , everyone recovers from this surgery at different rates . But I have yet to hear from anyone who has had 

it that regrets it.  Everyone I know of is very pleased with the outcome.

 I hope this helps you. 

Wishing the best for you in your recovery.

just me

 

Hi Steveinphiledelphia,

 

Here is a rather strange bit of advice.

It may help your confidence in the pads if you were to pour a measure  of water comparable to the   amount of urine  you  normally

void into the pad.  I believe you will be surprised how well they perform.

just me

  

Thank just me. I should have looked before I asked about the pads. I stopped in both CVS andRite Id today and found them. The store rand was pack of 52 :Max Absorbancy for about $9.00 at Rite Aid (The CVS were pricier and low absorpstion. Will try to tomorrow. Again, thanks for your guidance.

I was wondering if anyone posting on the thread had tried any other less invasive procedure such as TUMT before going to a laser solution? Can you please post your experience? 

Thanks.