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

DaveLosAngeles, 

   I went straight to Holep . No Regrets!

Holep was basically  my only choice because of the size of my prostate.  110 grams. Be careful and look into the different procedures,some of them have some patients that are not the happiest after their procedure.   In the end it is your body and you have the final say.  I can tell you I am very happy with the outcome of my surgery. Dont be afraid of holep . I was quite surprised at my quick recovery and progress ,it is a surgery however.

just me

Just me. I'm curious where you live and where you had your surgery.

SteveinPhiledelphia

I had my surgery at IU Health  Methodist Hospital  , by Dr James Lingeman .  He is the most experienced Dr doing Holep in North America. He brought it to North America and taught it to several highly qualified Surgeons.

Just me

Jonal, 

 I was wondering how you are doing? 

The exercises are paying off finally . The stress incontinence is less frequent,and less in volume.

Hi just me, thanks for asking.

I have been taking 150 mgs of aspirin daily as an anti-inflammatory. I don't know yet whether the aspirin is working in this respect, but it does reduce the pain to a really low level.

My next urine test is due in about 10 days. It will be interesting to see if the white cells in my urine have gone down from the 16,000 count. I am hoping that my body's repair system is coping without the assistance of an antibiotic.

I did read somewhere online, that the first big milestone in healing post HOLEP is about 3 months. I am at 82 days now, so only a week to go.

Apart from the pain which has always been tolerable, everything else is functioning well. I am still delighted with the volume and force of my flow.

My first urine retention and flow test is the first week in March. I am interested to discover how I am truly performing, and the measurable contrast between pre and post HOLEP.

I have to complete the IPSS sheet in preparation so that will also be an opportunity to objectively analyse the various elements of my urination profile. As I said to you previously I am aware that my frequency is still quite high after mugs of tea etc.

It is good to hear that you are progressing so well. As I said before it is just a matter of time before all aspects of urination come good for us all. Like you, even if I made no further progress I would still be happy with my decision to have HOLEP, as my situation is infinitely improved from where it was. I can walk into a public toilet and use the urinals without having to go into a cubicle for about 5-10 minutes due to the embarrassment over the time I used to take. I can get up during the night and be back in bed in about a minute, rather than the 20 to 25 minutes it used to take.

I remain a firm advocate for the HOLEP procedure, by the right choice of surgeon.

Jonal,

   I just had a cup of coffee , it did inspire me to head for the toilet. When I went there was very little volume.

This morning I slept through the night, 8 1/2 hrs.  I felt no real urge to go, but , as is my habit, I used my measured urinal and I had produced 525 mls.  I find it interesting I felt an urge at 120mls.after coffee but felt no urge at 525 mls on waking.  I hope this gives you some reassurance .  I just believe there is a lot of vitamin PEE in coffee, Tea , and BEER! 

  I appreciate the fact you have participated here and helped me through this . I ve noticed  there are others who have benefitted form our conversations with each other on this topic.

 I hope you are doing well .

just me

  

  

Hi just me,

Thanks for your comments, but I believe it has been reciprocal.

The fact that you managed to sleep all night encouraged me to ignore the urge and turn over.  It worked, I went back to sleep and  I manged to avoid rising until morning.  Whether I can repeat it again probably depends on on my fluid intake and the gap before bed.  To date I have usually managed about 5.5 to 6 hours before getting up.

Thanks for the feedback re the coffee.  The diuretic effect  of these beverages obviously increases frequency.  525 mls must be getting pretty close to the optimum for a male bladder.  I will have to measure my morning output again, but it has never been as high as 525 mls.  During the day I have never exceeded 200mls.

I have done more web investigation re my ongoing problem with the white cells in my urine.  It seems that I have pyuria which is a prevalent prostate post op condition.  See http://www.renalandurologynews.com/pyuria-microhematuria-duration-after-prostate-surgery-quantified/article/242304/  There is not much on pyuria related to HOLEP specifically, just conventional TURP, which is simply a different technique of tissue removal.

This possibility was never explained to me pre or post op, and my GPs have subsequently never really explained it properly.  Their approach has been to simply hit it with an antibiotic, when as I alluded to previously may be the wrong approach to what is probably a self limiting condition.  It seems there is a correlation between the incidence of it and the degree/weight of prostate removal, corresponding to duration of surgery.

 

 

jayp, all surgery has its risks, but I did my research thoroughly on HOLEP before commiting to it.  I think, as I said previously, the crucial factor is choosing a HOLEP surgeon with a proven track record.

As you can read from our posts we are generally delighted with our outcomes.  For me it trounces all the other invasive techniques.  There is as you say a steep learning curve with regard to the technique, and I think that the old expression "you can't teach an old dog new tricks" applies here.  The older surgeons have managed a fair degree of success with the traditional TURP which they still term the 'Gold Standard'.  My firm belief is that HOLEP is clearly the new 'Gold Standard'.

 

 

 

 

 

 

 

 

 

Looks like HoLEP is the future for prostate surgery. I thinkt that natural supplements are not going anywhere. The ones that are any good like Super Beta Prostate that contains beta-sitosterol and other minerals should still be taken to maintain prostate health. 

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SteveinPhiladelphia: I may consider HoLep w/ Dr. Akhil Das. Could you pl. let me know if you found him to be an expert and what you overall experience was, especially how long does it take to resume work etc. Appreciate your help very much. SAM

Hi Guest! (Feel free to sign in with a sceeen name - I found this group helpful). And I was going to post an update today anyway.

First Dr. Das is an expert and he is a heck of a nice person too! He's not always easy to get to but when he calls you he takes his time. My situation was a bit different because I scheduled my surgery the Friday before Christmas. (Dr. Das does surgery oevery Friday and alternate Thursdays. Normally the catheter comes out in 2 days and you are back to work - assuming no heavy lifting - in another day. In my case it was holiday weekend so Catheter staying in 3 days and during that time I fainted (from UNRELATED problem) and so they kep Cathether in 7 more days. That was UNUSUAL and I was getting blood in urine a few days. But not normal. The operation was smooth and you are asleep. You stay overnight at Jefferson Hospital and released next day. Care was great! Now, what I didn't know - that you will have seen if you've read this thread is that - even though you are back to work soon, you will have quick urges when you stand up. (while you are sleeping or sitting you don't have them). As I learned from the others here, that should go away in a few months. It's about 2 months for me now and you just need to prepare. I got Pads for my undershorts and they are cheap (55 for under $10) and comfortable. And Dr. Das prescribed a medicine (one in the morning) to help delay the urgees. Doesn't STOP them but they happen- maybe once or twice a day. I am OFF FLOMX though.

So I'd highly recommend the surgery - luckily Medicare pays for it! - as it is the least intrusive and I'm not big on hospitals.

Feel free to ask any other questions. BTW, my GP is at Penna Hospotal but they don't do Holep there and it was my DENTISYT - of all people! - who told me about Holep and Dr. Das.

Hi jonal,

  How are you coming along with your case of Pyuria?   . Are you still experiencing pain when you urinate?  I understand  your perspective  on trying to allow your body to heal itself.  I do hope you are able to overcome this soon.

It has been 4 months today since my surgery.   The improvement has been dramatic for me as you well know. 

It is interesting to me to hear of differing accounts in response to this surgery. It seems no two stories are the same. with on exception, improvement  in urinary function, and , satisfaction in the outcome as a whole.

  Consuming Coffee has caused me to have the urge while only having 120 mls to show for it .  I have checked this several times in order to give you an answer to you question a few weeks ago.

Last night  I slept through the night  and emptied out 550 mls ! There was no urge or discomfort with this  large amount. I am trying to hold my urine for longer periods of time and I have met with some success.  This amount is now the quite common for me.  This would have been unheard of prior to surgery.

I still experience stress incontinence at work , but it is also improving.

Hoping for continued improvement for you ,

just me

SteveinPhiledelphia,

  How are you doing after your surgery? 

It has been 4 Months since mine. Back to BETTER than normal! With the exception of minor stress incontinence.

Just me

Hi just me,

The pain is completely gone now.

My latest urine test showed that I had a two thirds reduction in white cells. Originally they were maintaining a 1600 level, now they are just under 500. My body is obviously continuing the healing process without antibiotics. A normal white cell count is below 50, so I am getting there.

All other urination parameters are excellent, apart from increased frequency after tea or alcohol, which you know about. I am not at all concerned about this as I feel that this is probably prevalent in the general population.

My next milestone is my first urine retention and flow test due in mid March. Once my white cell count drops down to normal I will also arrange for a new base line PSA test. We still have to monitor our PSA levels because HOLEP does not excise right to the periphery of the prostate, where a majority of prostate cancers develop.

I will have to step up my pelvic floor exercises and urine retention to strengthen the appropriate muscles. I want everything to be absolutely spot on as i get older. I have to avoid complacency and neglect just because everything is working so well now.

Just me, it is good to hear of your continued progress. Keep with the exercise programme they are obviously working for you. I am still getting up once in the night about 50% of the time, and I don't have the residual volume that you have. However, I believe we will eventually cross the finish line together.

For those of you reading these threads and still contemplating HOLEP, from my experience it was the best decision I have ever taken with my health. In the context of urination I honestly feel like I did in my 30's, and I had significant problems prior to this surgery. However, I would emphasise again that you must do your research and choose the right surgeon.

Hi Just me and Jonal:

I was going to post an update today and then I saw both your posts.

Today is day 64 after surgery. Unlike both of you, I have other health issues that creeped up at same time so it may not be the same. I was diagnosed with Irritable Bowel Syndrome – which (I’m learning) is a common ailment. It can be food related or emotionally related. In my case they think it’s the latter – partly because of anxiety after the surgery when I realized that the urges would be there for a while. I’m being treated by an anti-depressant drug that I take before I go to bed. It puts me to sleep and I may get up only once. When I get up and STAND up I head for the bathroom to empty a lot. But I’ll get up 3 hours later and have to empty again (though I took in no liquids after the first one.). But better than NO going (which was blockage problem before!).

I’m taking the new drug to stop urges (one each morning. Samples from urologist) and can’t tell if working but I Have a few urges during day. Those urges occur – of course – when I stand up and usually within 10-15 minutes of drinking a liquid. Still wear pads when I leave home. They are comfortable.

I keep TRYING the exercises but not sure doing right and they aren’t working for me.
I see surgeon again on March 13th (2 ½ weeks from now.).

So that’s where I stand. My situation with post-surgery is taking a back seat to the IBS – which we are treating with a few pills.

Unlike the two of you, I’m not measuring the output. I will say it’s a lot. But – again, as I said, I empty again a second time at night a few hours after the first one without taking in more. Oh well. I can deal with that.

Steve

Hi Steve,

I know something about IBS because my wife has had it for many years.

Personally I stay well clear of anti depressants, in fact any medicine that I don't absolutely need, because there are usually unwanted side effects.

The best advice I can proffer with regard to your urination progression is to repeatedly do the pelvic floor exercises.  It can take some time, but matters should improve eventually.  You must be both persistent and consistent.  If you are still unsure of how to do them, ask your doctor to physically check that you are doing them correctly at your next consultation.

jonal