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

Sunshine:

I recommend getting evaluated by Dr Miller. If it were me I would wait and have her do the cystoscopy. That way she can look for whatever is relevant to her needs in regards to your best interest. I was very happy that my hometown urologist had not done the procedure and therefore Dr Miller did it and had a first hand look. As far as size --- Initially I felt that I was jumping the gun due to the relatively small size of my prostate compared to others on the forum, but the cystoscopy convinced me that I was not (I saw concrete evidence on the computer screen that my bladder was already suffering -- ie: ridges and the beginning of a diverticulum as well as a nearly obstructed bladder neck). Following the cystoscopy Dr Miller assured me that I had made a good decision to get something done. The lesson I learned was that one should go by their own symptoms and whether they are comfortable with their situation. If not --- then do something about it sooner rather than later.

I have zero regrets and I feel like I have a new lease on life. Of note: Amazingly I seen to have NO post-op complications. I attribute that to my not letting things drag on too long, and the skill of the surgeon.

Sunshine:

FYI: You can also reach all the doctors via email if you do a search online. This forum stupidly does not allow posters to post useful links but they are available if you just dig a bit. I much prefer to communicate via email as it gives one time to think about responses and it also leaves a paper trail.
Leaving a phone message will surely get results also.

All I had done locally was PSAs, and biopsy with associated ultrasound.

Once you get engaged with any of the HoLEP doctors I am certain you will be surprised how efficient and accommodating they are (especially if they are associated with a teaching institution or a large clinic organization).

Best of luck.

Hello Sunshine & Everyone Else:

Forgive me for also not signing in for my previous post.

I just had HoLEP surgery on 1/17/2018 at Vanderbilt University, by Dr Nicole Miller.

In order to give back some of the benefits of this forum, that turned out to be so useful to me, I will post several chronological reports relating to my experiences so that others can benefit. 

3rd Report --- 11 days Post-Op:   I have so little to report that I was not going to do another report until the time of my six week post-op visit with Dr. Miller.  However, since Sunshine asked, here is what little I have to report.  I am having zero post-op complications to date.  I feel like I have a new lease on life!!  My urinary flow is controlled, very strong, and uninhibited.  I only had a little bleeding post-op --- always associated with pressure on the perineal area (ie: too much continuous sitting on a soft surface on the ride home).  Still have a dull ache in the area of the prostate --- but I had that pre-op -- just not quite as much.  I am hoping that it is nothing to worry about.  I am truly amazed that I am not having any of the common complications that so many people have.  It is purely conjecture, but I attribute most problems to people who wait too long to be treated and also the technique of the surgeon.  I got very lucky.​ Regarding my 12 hour drive back to Florida --> the pressure of the soft seat pushing on my perineum for long periods of time aggravated both my discomfort and also resulted in a slight increase of bleeding with each void.  That said, the problem improved significantly when I made efforts to stop more often (as they had instructed me to do before I left the hospital).  If I had it to do over I might consider purchasing some sort of doughnut shaped pillow to sit on for the ride home.  Post-op I was on 7 days of Pyridium to decrease urethral irritation.  This was effective although I still had some minor discomfort.  Now that I am finished with the medication I have only very minor urethral discomfort.  Other than the minor bleeding and urethral discomfort I have had none of the commonly mentioned post-op complications such as:  incontinence; dribbling; urgency; severe pain; inability to void; post-void residuals; retention; etc..  I also have resumed having strong erections although I have made sure to not climax for two weeks per the post-op instructions.  I am amazed and over-joyed regarding how well I am doing.  I hope it continues.

My next report will be after my six week post-op follow up evaluation unless something arises sooner.

Thanks and best wishes to everyone.

Sunshine:

From your description I believe you will definitely have the surgery (medication needs and scan results).

Personally, I would have the surgeon (Dr Miller) do all the tests so that she can see first hand.

Yes - I drove -- yes - I am a control freak. No different sitting in the driver seat vs sitting in the passenger seat. BUT - you must stop frequently (ie: everytime there is a rest area and also for gas more often). Also, I strongly recommend you stay at the Holiday Inn another night after your discharge to make sure you are not going to have any problems. Also --- watch the weather and I suggest arriving early or leaving later if the weather is expected to be poor.

It is not absolutely necessary, but you might want to recruit a friend to go with you if you have surgery --- knowing that you have a back up person will decrease your stress which is important.

In addition: Take the urinal that you use in the hospital with you upon discharge --- why: because after the procedure and catheter you will not always "shoot" (pee) straight and using the urinal minimizes messes.

Be sure to sign up for the portal and also put the app on your phone. It is very useful and well put together! On the portal you can see lab results; communicate easily; see your appointments and how to get there; input your medical information.

A little FYI: I would like to also point out that if you go ahead and have the surgery --- you probably will find the large irrigation catheter very uncomfortable. As a health care professional I knew to minimize my use of pain medications (I did not use any) so that I would not have difficulty voiding post catheter removal.

Both before and after my appointments and surgery I was VERY careful to not catch the Flu or a cold from the general public. I tried to stay away from the public and possible sources of contamination as much as possible. Also, carried hand cleaner with me everywhere I went.

In closing --- I think you should expect to have more post-op complications than I did. I think from reading this forum that I had exceptional luck. That said: I believe that both Vanderbilt and Dr Miller provide exceptional care and are significantly responsible for my good luck.

Question regarding sex after HoLEP:

I know all about the expected retrograde ejaculation, etc..

My doctors said i should abstain from sex for two weeks after surgery.  Well that time is coming up for me and I was wondering what to expect other than retrograde ejaculation?  More specifically is it painful or cause bleeding??  I am almost afraid to do it since I don't know if it will cause any such problems.

Thanks for your input.

Hello Sunshine:

Glad to hear that you are getting underway towards a resolution of your problems.

I am certain that Dr Miller will provide the best possible care. She and the Vanderbilt organization function exceedingly well together. I give them an A+

That said, I will point out that your prostate is significantly larger than mine so there is a chance that you may experience some of the post-op difficulties that others describe on this forum. However, those difficulties seem to resolve with time and effort. I believe that I was exceptionally lucky not to have had any issues at all.

In regards to your prostate size --- you must deal with the issues as they are now --- regardless of past history. You have an enlarged prostate that is resulting in urinary difficulties and a dependence upon medications to deal with these issues. Now is the time to get something done. Don't wait for your bladder to be more damaged, and other complications to develop.

Make an appointment; Have your medical and insurance information sent; Make a Holiday Inn (has the shuttle) reservation via Vanderbilt Guest services (get the number from Hallie); register with the Vanderbilt Portal (on both computer and cell phone); and if possible recruit a support person to tag along ----- Then just kick back and look forward to a much improved future. Believe me I was scared to death (especially since I had never had surgery or even a previous hospitalization) but everything flowed smoothly and I feel like I have a renewed lease on life now. I wish you the best of luck.

PS: Throughout the entire process do everything possible to avoid getting the flu. My wife and I resorted to extreme efforts in the regard and it paid off.