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

Oops, I forgot measurement of urine flow rate and urinary retention at both pre-surgery appts as well.

I underwent HoLEP at Vanderbilt University Hospital on 8/14 (slightly over a week ago) very successfully. Aside from a mild burning when I urinate I have had no side effects. I have been self-cathing since I had heart surgery on 1/14. My bladder has to relearn holding back but I have a very strong stream. Thank God!

Thank you for taking the time to respond to me - I appreciate the feedback. I have 94 cc volume, large median lobe and several hypoechoic regions that may make the procedure take longer -- and the longer the procedure the greater the risk of incontinence and dysuria because of the increased manipulation of the urethral sphincter. I am concerned about both. Did you have either incontinence or dysuria and, if so, how long did they last? Did you allow trainees to participate in the procedure? Because of my situation, I would like to have only Dr. Humphreys' hands on me, but because Mayo is a teaching hospital, I am hesitant to request this -- do not want to annoy or anger the doctor whose hands my prostate will be in!

I understand your concern! You should definitely ask Dr. Humphreys about that, but I'm pretty certain that he performs the surgery. Liabillity-wise, he alone is responsible, too. Underlings may observe (or take supportive roles during surgery) and take care of the followup. Be sure to write down all questions so when you meet with Dr. Humphreys pre-surgery, you get all the information you need. Other than seeing him again (briefly) during surgery day prep, you won't see him again until the follow-up meeting 3 months post-surgery. I have seen a comment that Dr. Humphrey's is difficult to get ahold of outside of his normal scheduled appointments. This may be true, but I never needed to do so. It's the modern way in medicine, it seems. I never expected to speak to the surgeon outside of our normally scheduled contacts, and I was never disappointed, nor felt any lack of response to any issues that I brought forth. He has a protocol set up for all aspects before, during, and after the procedure. As far as incontinence, I had minor leakage (usually exertion induced) and minor disuria for up to a couple months post-surgery. I also had blood in the urine longer than expected, but it was all cleared up completely by the 3 month follow up appointment. It was the most positively impactful surgery I have had in my life. Of course, that means I've been fortunate to have been otherwise pretty healthy in my 60 years on the planet. Good luck, and feel free to keep asking questions, this is an amazingly helpful forum in that regard.

I do not know if it contributed to any differences in surgery or outcomes, however, given that I had never had a cystoscopy, flow study, ultrasound to determine retention, etc., I felt very good about these tests being provided at Mayo Clinic under Dr. Humphreys direction. I wanted no issues with my insurance paying for the $30,000+ surgery and hospital fees. I live in the Phoenix area, so for me, it was just as easy to have the procedures done at Mayo as it would have been at another clinic in the Valley. I would assume that Dr. Humphrey's does indeed collaborate with other urologists to streamline his process as much as possible for out of state (or country) patients. He did state that he had patients flying in from all over the world for the HOLEP surgery, but I have no way of knowing how much of a pre-surgery workup that foreign patients bring from their own urologist versus having that done at Mayo. Take care!

I had my surgery at Georgetown Hospital in Washington DC. I traveled 1000 miles for the procedure. I was able to set up the surgery in advance and my doctor saw me the day before the surgery to perform a prostate ultrasound. I stayed one night in the hospital and was back home the next day. I can't ask for better.

Hi
I had a HoLEP operation 3 weeks ago on Aug 9th. Although I was released the next day I went into chronic retention and had to have a catheter fitted for 7 days. I passed my TWOC and urine flow was much better but less than two weeks later it has declined and I am suffering abdominal discomfort - presumably from urine retention. I am now very worried that the procedure has not been a success and a block remains or even worse the bladder is damaged.

Sorry to hear about this. In my pre-surgery visit, my urologist told me that something like 10-15% of holep patients develop strictures, necessitating a second surgery. I wonder if you are not in that group?

Best.

First, a big thank you to JustMe, Jonal and others who have posted here. It was a great help to follow their experiences as Holep is not a great topic for dinner conversation. I wanted to post my experience in the interest of informing others.

I had Holep surgery 7 weeks ago at the Mayo in Az with Dr. Humphreys. I was very satisfied with the experience and am pleased with the outcome.

My prostate was around 230gms and I was running PSAs of 30s-40s. I had two previous biopsies (negative) over a ten year period. Cancer was definitely a concern…but sampling a prostate that big was not very useful. Urinary blockage got me to an emergency room in April. That and the subsequent requirement to self-catheter was the last straw. My urologist recommended open-simple prostatectomy due to size. I brought up Holep and he agreed it was a good option and provided the referral.

It is a 4hr plane ride to Phoenix from my home so I wondered about the pre-op. Although the visit was brief, I think it was critical for both the Dr’s assessment of me and my assessment of Mayo. I came away mentally prepared for the surgery. While there are a lot of metrics for assessment…there are still intangibles and the pre-op visit helps with both. Staff at Mayo scheduled detailed testing around my surgery date to accommodate travel.

Surgery in July. Out in 24hrs. Bleeding stopped in first week however slight bleeding at two weeks (sloughing as a result of healing?). Serious incontinence which has persisted although dramatically improving through week 7. Very frustrating and embarrassing…but all better than self-cath! Do your Kegels; they seem to help. It is hard to exercise a muscle you can’t see and have taken for granted for forever. In my case I am sure I have a lazy sphincter and muscular bladder. Down to light pads from heavy and hoping it fully resolves. Around 180gms removed and no cancer (yeah!). Of course there is never a guarantee of being cancer free.

It is interesting to see the diversity of experience among Holep patients. I am 64 and looking forward to full recovery. Back hiking and at the gym. Another thought. After blockage in April I had a Foley catheter for 5 days…result was infection and 102-103 temperature. I am totally behind prophylactic antibiotics in this case. Infection can be a persistent and serious complication.

Finally. thank you to the Mayo, Dr. Humphreys and his team for skilled and attentive treatment.

Hello Betternow,
You are more than welcome, I know the dramatic improvement this surgery can make. I also know the apprehension having surgery can bring.
Going through this together with Jonal was a big help. This site was good for us as well, as we helped each other along. Steve entered in as well. If what we experienced and passed on was helpful, it makes our experience worthwhile. There is truth in the old concept if you want to be healed, help someone else.
I would be interested in hearing what you PSA drops to when you have it tested. Mine went from 17 down to 0.36 within 6 weeks.
All the best,
Just me

I had this surgery on 20th April. It took a good few weeks to get drip-free but it does eventually happen. My PSA was between 17 and 21 on the 3 tests I had done prior to the procedure and a check after 12 weeks took it down to 1. Negative cancer in the biopsy I had in Jan (32 samples) and negative also on the extracted material so that is a big relief. They took out 95 grams so I had a pretty large prostate. Flow rate is fine and the period between toilet trips is going on for about 3 hours. I am certain that in this regard I am much better than before the op. I never have a sudden urge, I can put it off for ages which I could not do before.

The lesson learned from this is that PSA in itself is not a good indicator, the biopsy triggered the gland to swell causing urine retention needing a trip to A&E, a catheter in place for 3 months (agony!) but I am now overall in a better position than before when I had a routine blood test that flagged up the high PSA. MRI was not an option as I have an implant in my head.

The surgeon said he would fall off his chair if I was later found to have anything sinister.

five days post surgery, am getting false urges today. But blood has disappeared and stream has been good enough to cause bubbles in the toilet water. Some pain in the area last night after sitting for three hours. Gone this morning. Sleeping well enough. I blame my bad shoulders more than the Holep I had. False urges are nothing abnormal, right?

They are normal. Hang in there, it gets better.