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

Hello:

I recently 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. 

4th Report --- 22 days Post-Op:  As I have previously stated I have had few of the usual post-op issues.  22 days out I can say that my only issues are:  1) An ongoing soreness in the area of the prostate which seems to be aggravated by sitting;  2) A tiny bit of blood in the urine, at the onset of urination --- this seems to be aggravated by sitting.  Actually, I have no blood if I do not sit much.  3)  A small amount of urethral discomfort when voiding --- this seems to be also aggravated by sitting.  This discomfort may be referred from the prostate rather than actual urethral discomfort.

I have recently increased my activities and here are the results:  1) A couple days ago I did some very moderate yard work.  It resulted in a worsening of all three of the above mentioned issues.  I was very disappointed but it was a lesson learned.  2) 17 days post-op I engaged in sex for the first time.  I had been afraid that it would be a painful experience that would result in more bleeding, but I was pleasantly surprised.  Erections were as good as ever.  Climax resulted in No pain and there was No subsequent bleeding or other issues.  My first climax after three weeks of sexual abstinence was very strong with sensations similar to pre-op experiences.  I do not know if I actually ejaculated (the normal way) any semen but I had the sensation of producing a significant volume.  That said, subsequent climaxes were much more muted ---- specifically:  I had good erections followed by a faint sense of ejaculation and a subsequent fading away of the erection.  I am nearly certain that the ejaculation was small in volume and retrograde.  This was a significant disappointment for me, but at least I was able to perform and satisfy my partner.  Lesson learned:  Make the first climax of a session count as it will be the best.

I wish everyone the best of luck with their HoLEP experience.  My best overall advice is "Just do it".

You are correct in regards to retrograde ejaculation. Dr Miller told me that: "I should expect to have retrograde ejaculation if she did her job correctly." Those were the words right out of her mouth.

I do not believe stress incontinence is at all related to retrograde ejaculation. The primary means of correcting incontinence issues is to do Kegel exercises both before and after HoLEP surgery without fail.

Dr Miller gives her patients a handout entitled: "Pelvic Muscle Strengthening for Men having Prostatectomies or HoLEP." She goes on to specify the three pelvic muscles: 1) The bladder; 2) The Sphincter muscles. These muscles help you open and close your urethra; 3) The pelvic floor muscle, also known as the pubococcygeus or PC muscle, that support your bladder and rectum and helps control your urine flow. She then describes in her "guide" how to do the Kegel exercises that "can help improve bladder control and possibly improve sexual performance."

So - In answer to your question: She said that Kegels do help correct urinary dysfunction issues and they strengthen both the sphincter and PC muscles.

Descriptions of these exercises can be fairly easily found on the internet if you do not have a copy. It is important to start these early and stick with it through the post-op period.

Sunshine: (a response to your questions)

At Dr. Miller's office: Jes does all the scheduling & Hallie is the nurse manager. Both are above excellent, however, I found that occasionally they did not respond to emails and required some prodding such as resending the email, or as a last resort sending an email to Dr Miller stating the issue. Everyone came through in the end but waiting can be frustrating.

Jes was able to schedule me as follows: 1st day was pre-op introduction and workup; 2nd day (the following day) was surgery. These appointments were made much sooner than I had expected but I was told that Dr Miller sets aside spots for out of town appointments.

I stayed at the Holiday Inn nearby (which was recommended by Guest Services) because they gave a discount to patients; they were very close by; and they had a excellent free shuttle service. That said, I did have to use Uber (my first time) on the day of surgery because I was told to report before the shuttle service hours started.
I made reservations for the night before my first appointment through the night after my discharge --- a total of four nights. I realized that I would not be using the room on the third night but I did not want the hassle of moving all my stuff before and especially after surgery. I also wanted a place that my wife could retreat to in case staying at the hospital was not comfortable. (However, she was able to stay with me). I think my plan worked out very well and I recommend it.
Insights into hospital charges: I was able to get each of the 4 nights for between $100 & $150 each night. BUT, when I was leaving I went to make a reservation for my follow up visit and found they were going to charge me about $300 a night because there was some event going on and the rooms were in higher demand. So for the follow up we went with the Holiday Inn that is at Brentwood. I have not figured how we will get back an forth. I did check and see that Uber charges about $20 - $30 depending on time of day.

So there you have it. Feel free to ask any questions that you have. I would like to facilitate the process as much as possible.