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

Hi klink, just wanted to give you and all an FYI that I seem to be experiencing the exact same extreme IC you have. Cath came out today, I urinated enough to leave the office (experienced some dribbling but they gave me pads). Decided to walk from Dr Das's office to the CVS 6 blocks away to get some stuff the wife needs (has a bad cold) and to make a long story short, by the time I got to the hotel the entire front of my jeans were SOAKED! I don't think the pads I have will be sufficient to control this, everything seems to go straight thru me, and as with you I don't get an urge to pee, it just comes out every time I move. So I am waiting for my bladder to empty as much as possible and am going to suck it up and try to get back to CVS and get some Depends maximum pants to hopefully allow me to drive home tomorrow to DC. Hoping as with you I will see some incremental improvement over the coming weeks.

Update:Did some research on the IC situation and (though I will need to confirm with Dr Das) I believe the extreme IC is caused by damage to the ureter sphincter that occurs in varying degrees during HoLEP. Since my prostate was so long and Dr Das had to do a lot of work to reach the tissue and get it into my bladder, I assume my ureter sphincter was probably stretched and damaged more than usual, hence the severe IC I seem to have. Doing kegels helps by strengthening the underlying muscles in that region but I believe the ureter sphincter will need to heal before I see real improvement. Not idea,l but at least I think I know what I am dealing with. Got the Depends pants which seem to help. Now I just need to get over my fear and start drinking again and handle this as best I can. More to come when I know more.

Hi Blayneb, I have had you in my thoughts this past week! Glad the surgery was a success and the care at Jefferson was exceptional like it was for me...also very happy that Dr. Das didn't have to make that additional external incision. Very good news, sir!
Sorry about the IC......it is most frustrating. I hope your research proves accurate....but man it seems slow to improve. I have had several out of town trips with customers and have had leakage problems. Am carrying spare pads, underpants and pants with me wherever I go. Its so much easier to manage here at home, I sit a lot at the computer, and don't seem to leak as much sitting, but whenever I get up I head straight to the bathroom. Sometimes I can void on my own (albeit a weak stream), sometimes not. When i wake up at night I have a very powerful stream and a rapid one, not so much during the day. Had a formal event last night, my pad shifted under my suit and it wasn't pretty. That being said at least now I can feel when I am peeing, that wasn't the case earlier. I just HATE that i happens virtually every time I stand up, no matter where i am.....especially after sitting awhile (like a two hour dinner last night).
Other posters have suggested sitting to pee and I must admit that has helped some. Tomorrow I will be five weeks post surgery, and the improvements are slow in coming. I get depressed and upset about it but in the big picture I am cancer free and understand that this will get better. If I could just stay at home or control short trips I would be so much happier...but the travel will pick up again in early January and I really am not looking forward to it.
I have experimented with different pads and again, thanks to previous posters here, have found the Tena Level 3 to be the best for me. Only available online, at the Tena website, but they ship out of Virginia and I usually get them the next day or the second day. Have tried the other Tena pads and Depends Guards available at Walgreens, but the Level 3 is MUCH more absorbent than the others and worth purchasing them online I believe...... at least in my situation where I have been completely incontinent for weeks.
I had the same fear, Blay, and was afraid to hydrate. Well don't fall into that trap or you will experience other problems for sure. I force myself to drink even when I don't want to.....I think you have to drink fluids or riskj getting dehydrated. I even sometimes kid my wife that I might as well pour my glass into the toilet rather than into my mouth and that way I can cut out the middle man!
I go back to Dr. Das for a follow up January 18th, I am interested to see if the IC improves by then (heck its another 3 and a half weeks from now). It is SLOWLY improving now.....but slowly is accurate!
I again thank all the posters on this forum, the time spent posting their experiences is so invaluable to so many of us.
And here is a wish for a very Merry Christmas to all who read this! Merry Christmas and Happy New year!

Thanks much klink!. I really feel for what you're going through. I am luckily retired. The thought of having to put up with this when I was working a few years ago would have been unbelievably stressful. I only hope things will improve for you soon. Please do those kegels, at least 3 times a day. I found an Australian sight that has a good PDF on how to do them correctly. ***this post is edited by moderator *** *** posting of web addresses is not allowed*** Please read our Terms of Use hopefully the url remains available as I typed it. I have fortunately had some incremental improvement. The same day I came back to the hotel that I described earlier I was able to eventually retain urine without it spontaneously flowing out. I was so thankful. Having said that however I continued to experience Stress Incontinence. My situation has remained the same since then - I can retain urine until I feel an urge to go (including the 3 hour drive back from Philly where I only had to stop once - btw Dr Das called my cell the morning we were to return to make sure everything was ok for me before I made the drive. He's really a caring Dr.). I can sleep mostly through the night and retain urine, at least for about 5 hours or so. The urge now is not the same as pre-op, but I am beginning to recognize the feeling. So I drink normally (not too much or too little) and when I feel that new urge, I go ASAP. I have blood at the beginning and a LOT at the end every time. My stream is quite strong (like a fire-hose I tell my wife) which is great, but my main concern right now is that the blood does not seem to stop. It is present every time I go, and drips out of my johnson at the end of every urination. It is mainly bright red. I try to get out as much as I can without pushing as Dr Das told me not to do (so as not to "knock anything off"). My question - did you experience much blood and if so, when did it stop?

So right now I experience Stress Incontinence with the outflow being pretty much a blood/urine mix. I am using Depends briefs along with a pad (think I'll try those Tena L3s - thanks)which I hope to bring down to just a pad eventually. I am fortunate in that I am mainly dribbling and not experiencing a real flow of urine when I do have stress (which I try to limit, I also squeeze ala kegels when I sneeze or cough or laugh, etc.). The drips are fully retained by the pads. I am changing about 3 to 4 a day.

You'll continue to be in my thoughts and I really hope you start to see improvement soon. Have faith as I do that eventually these symptoms will abate as they do for almost all HoLEP patients, and a year from now (if not sooner) we'll both look back on this and be very thankful we did it. I remain confident we both will. If I can do anything to help you please reach out.

Merry Christmas and Happy New Year to you and all here!

Glad you have had some incremental improvement Blay! I did not have much blood at all once I left Jefferson. It potentially may be from where the instruments caused some irritation that needs to heal. We all are different in how we heal... I had some chips for two days about 3 weeks post op but hardly any bleeding at all when I came home in the early weeks of recovery. Glad your retention has improved, sounds like great progress!
Hope you have a very Merry Christmas Blay!

Thanks klink, Merry Christmas to you too.! Yes I am thinking due to the length of my prostate and the amount of manipulation he may have had to do, this is the result. I will give it until Thursday this week (1 week after cath removal) and if I don't see some improvement in the blood issue I will call Dr Das's office to see what they think.

Looking forward to 2018 and major improvement for us both!

I don't know if I'm replying to Blayneb or this is a new post but either way I guess it will be seen. I live in Louisville, KY. I have a very large prostrate and have been taking Flomax and Finasteride for 1 year when my Urologist retired. My new Urologist suggested I get the Holup surgery. I'm 77 yrs old and had Holup surgery about 11 days ago. Overnight at the hospital and released the next day. The next night was miserable. I had the urge to go every hour just dribbling. The next day I started dribbling with a small squirt. I was back and forth for about 3 days some better than others.. I was just about ready to go to the emergency room and have a catheter inserted then on the 4th day, that afternoon, I passed 2 blood clots and things got a lot better. There was a lot of blood till around the 5th day I think and then it turned pink and was gone by about the 6th or the 7th. At night I sleep from 2 to 21/2 hrs and then i get the urge to pee and pee like a race horse like the others on here have said. I told my wife that I have to lean forward when I pee to keep from being blown back off my feet.
So far during the day I have leakage and wearing diapers which isn't that bad once I got use to them.
I finally found that if I make myself go to the bathroom about every 2 hours that I can make a diaper last about 6 to 7 hours with out changing. So far so good!
Thanks for listening and hope it helps.
There's no better feeling than a clean diaper!!

Hi Don. Whether you replied to me or not does't matter, we're all together here sharing our experiences. Sounds like after a rough few days things are getting better for you. I am wondering if you Dr had your bladder flushed prior to your discharge? I was flushed overnight (12/18 I had HoLEP) and kept a cath in for 3 days before it was removed and so never had the issue you had with urge and just dribbling. Once I had the cath removed by the next day I was peeing like a fire hose just like you stated, with a force that is almost scary. My issue was a lot of bleeding and post urination pelvic pain that lasted for almost 2 weeks post-op. Just this past weekend it has finally dissipated significantly so now I only see a very little blood at the end of urination. I do dribble and wear pads. I graduated from full Depends pants after 4 days. I am able to retain in my bladder at night for up to 7 hours before I have to go which for me is amazing. For now I am very encouraged and hope to see significant improvement with the dribbling over the coming months (which is Stress Incontinence) as I have done kegel exercises for years and continue to 2 to 3 times a day.

Wish you the best! Please keep us updated and I hope you see continued improvement.

Blayneb'
Thanks for your quick reply.
Yes they did flush my bladder if that's what they do when you have the catheter in and they fill a plunger with solution and squirt it through. I had absolutely no pain except the usual burning sensation while I was dribbling the first few days. The same pain that I used to have at times when peeing before surgery. That's finally gone.
If I remember right I had some pelvic pain right after the surgery and they gave me pain meds. but that's the only time.
I would see a little blood at the end of urination also but that's gone now..I wish I could go for seven hours before I had to go but I guess that's later.LOL
I might give the pads a try and see if I can handle them.
Wish you the best also and the same for continued improvement.


There's no better feeling than a clean diaper!!

Sure Don. Yes that is how I was flushed too with a 2 way catheter and bags of saline. Can I ask who your Dr is and where you had HoLEP done (I had Dr Das at Jefferson Hospital in Philly)? Sounds like you're moving in the right direction. We're all different and I bet you'll see continued improvement in retention time as your bladder adjusts. If you're not doing kegels/pelvic floor exercises you might want to do them for incontinence. You can find instructions on many web sights.

Good luck and all the best!

Blayne,
My docs. name is Dr Trevor Soergel. I had my surgery at Norton’s East Hospital. My guess is that he’s in his early 40’s. Really a nice guy. I met him at the hospital when I was having a catheter inserted because I had blocked up. He ask me who my urologist was and I told him no one that mine had retired. He looked at me and said “well you’ve got one now.” That’s when he said he wanted to do the Holup once he got me out of the mess that I was in.
I’m going to check on the levels. Thanks for the info. You keep doing good also and I will keep you informed.

Check on the kegels. Damn spell ck.

So that's in KY Don? I only ask because we usually share which Drs we used and our experiences. Sounds like he might be a good one. I see he went to U of Indiana so he must have learned HoLEP from Dr Lingenfeld one of the best in the country along with Dr Das (those 2 have done more HoLEPs than anyone else in the US as I understand it, and brought the procedure here from New Zealand). You're welcome for the info and if you need anything else please don't hesitate, Do check on those kegels, they're a must to help manage and recover from incontinence. All the best.

Blayneb,
Yes, Louisville. The group he’s with have offices in southern Indiana also. First Urology is the group. Thanks again for the info and I will check on the kegels.

What tests do i need to do with my local URO, to send to Dr Lingeman before I get an appointment for HoLEP?