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

Max healthcare India, Dr. Anil Varshney, an absolute master with 7,000+ procedures under his hands. Holep performed on 19 May, Cath removed on 23 May, urinated, tests, and released. 4 days in hospital, private room, no pain, 1st class treatment all the way. Total cost was $6100, insurance coverage 80%, out of pocket $1,220, currently pissing thru a garden hose experience! You can find pricing starting at $3,000 up. The proven experience and quality worth every $ spent!

I'm late to this forum, but thought I'd throw in my 2 cents.

I had HOLEP recently. Was intrigued by blue light focal laser ablation (FLA), but insurance wouldn't cover it, and there's not enough long term evidence to know if it would have to be repeated soon or not. TURPs appeared barbaric, even the newer ones, green light laser has a few issues, including often having to be repeated and you can't screen the removed tissues for cancer, and so HOLEP rose to the top as the obvious, best, choice for a large prostate and fast recovery times with the fewest complications (out of all of the dizzying array of choices). I personally will agree with studies that claim it to be the current (mid 2018) gold standard.

I went with Indiana University, Dr Krambec. She was fantastic. She learned from Lingeman, and he recruited her from Mayo to work with him again, for good reason. Check out Krambeck's resume on the IU website sometime - it's impressive. She's also super nice, as was the entire staff, and their system of consult one day, surgery the next is convenient. I'm sure Mayo in AZ with Humphries would be fine too, he studied with Lingeman also, but it was much less convenient to go there. And surprise, Indianapolis is actually a nice town with parks, museums, great restaurants, and we even got to watch a minor league baseball game. OK, it wasn't really a holiday, but it was a nice surprise.

Cannot say enough good things about HOLEP, and really, I would just be reiterating all the positive messages on this forum. I had about 100cc removed and life's much easier now.

Feel free to ask questions, I'll make an effort to respond.

My prostate was over 100 grams that caused extreme health issues with uti's, epidymitus, loss of sleep, loss of weight and has left me out of work for months. In addition, lingering health issues such as stomach issues are still part of much needed healing. Had the operation on May 1st at OSF Hospital Peoria, IL. which seemed to go well.

Glad that the surgery is over and can pee like a canon, but have not had much improvement with incontinence, even though it's been two weeks. Any advice or wisdom would be most welcome. I've been attempting the kegel exercises three sessions a day, but that has not seemed to make any difference. Generally how long has it taken for bladder control and continence to return. Thank you and God bless to everyone.

Everyone’s different. I’m into my 5th month and still wearing pads. Some days I feel like I don’t drip/squirt any and some days 1 or 2 times a day. Everyday is different.
I wore diapers for about 2 months and then switched to pads. Good luck.

Hi Father Greg. Similar to Guest, I am in the first week of my 6th month. My prostate was 150 cc and was difficult to deal with due to it's length per my surgeon Dr Das in Philly. I still am dealing with incontinence issues but it is vastly improved from the levels I experienced initially (I can take a shower and dry off without dribbling on the floor like I used too - a small victory I celebrate). I will stress it is SLOW progress. It is more week to week or even month to month. I sill dribble and wear 1 or 2 CVS Light Duty Shields a day depending on how active I am that day. At this rate, my guess is it will be another month or even 2 before I might be fully continent. I do kegels daily as much as possible. My local urologist told me to do them as often as possible, you cannot do too many. Standing, sitting, laying down, whenever. Just make sure you're doing them correctly. There are many resources on the web to help. Patience is the key word. Good luck and know that we're all here to help as much as we can.

Thanks for your response and encouragement. How soon were you able to get back to routines without too much trouble? For me, one the flow starts, there is no stopping and therefore have to have quick access to the toilet

Thank you for your reply. Has the "return to normal" come gradually or did you wake up one day with an "aha moment" that everything is much better.

Expect it to be gradual sorry to say. Luckily I am retired and was able to limit my activity during the first few weeks. It took a good month before I regained enough control to feel more assured to do daily things like going to the store etc. For me during that first month or 2, I used incontinence underwear if I had to do any longer term activity and light duty pads when I was at home and could remain less active. I also emptied my bladder frequently. This is not encouraged (we need to retrain our bladders to hold urine) but it was the only way I could manage things those first few months. I am assuming you're much better when you sit or lay vs moving around. Everyone is different. You could see improvement week to week over the first month or 2 like I did, and then slower steady improvement month to month as I am now. Hope this is somewhat helpful. It is hard to be patient I know. Just remember those kegels (if you had never done them before they will take time to strengthen the muscles down there). Wish you the best.

My dr. said to "train" the bladder to let go every two hours. So far I've found that impossible and usually go every hour. How much water did you drink every day? I've been trying to pace myself with about two liters thruout the day. I very much appreciate your insights and wisdom from your experiences......God bless

Glad to help! My Dr advised me to just drink normally, no more or less. In other words, don't drink a bunch more or less due to the surgery, just try to maintain your normal levels assuming you keep yourself hydrated a healthy amount. Let me also tell you that I experienced a good bit of urge incontinence in the first month or 2 whereby I had to get to a toilet within 20 to 30 seconds max (why I wore the pants if I felt I might be far from a toilet) when the urge hit me but that too improved a lot after the 2nd month. The kegels really help there. More than glad to try and be helpful. Feel free to ask any questions. Please keep us abreast of your progress. Regards.

Did you have normal ejaculation or was it retrograde?

Retrograde Buster. This is a normal side-effect of HoLEP and occurs in 100% of procedures as far as I know. The internal urethral sphincter is destroyed during the procedure (as was explained to me by my Dr). Semen then goes into the bladder since the internal sphincter for all intents and purposes is gone. The orgasm still feels good, but I will say it has lost some intensity. I can live with that in order to pee like a normal person.

Thanks, I just wanted to verify the situation.

About a month out from the procedure I had several normal orgasms. Since then it has been without any intensity. It seems strange.

First time I did. Since then though - nada.

Hi Father Greg,
I had my HoLEP done in Indy at Methodist hospital br Dr. Krambeck on JAN. 31,2018. I am 3 1/2 months out. I have improved, I am using a light shield overnight and a moderate pad during the day. This much better than the first week or two, I was wearing a pad inside my aper underwear. It may have been overkill but it gave me confidence. BTW my prostate was about 214 grams and they removed about 100 grams! I am looking forward to the time I can just use shields and then nothing.