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

I see him on the 13th. Probably not doing excercises right. Will ask doc. No accidents yet. Finding that I'm now up 2-3 times a night (better than before) but no Flomax or avodart. Still taking the Myrbetiq Mirabegron 25 mg extended release for urges. No side effects yet. (I'm on a 30 day sample). By the way a friend's son-in-law is a Urologist in Cherry Hill, NJ and she said that he performs HOLEP over there too. Thanks for checking in Jonal.

Jonal and Steve, 

   I have seen some great improvements this last week.  Sleeping through the  night ,and voiding over 500 mls with no discomfort

or urges!  Stress incontinence is improving rapidly!  Very few leaks and very little volume  when I do.  While running errands tonight

I held off urinating almost 45 minutes just to see if I could.  Unheard of  even 2 weeks ago!  

  Steve , It might be an encouragement to you if you were to keep a journal of the volume you pass . It can inform the Dr as well.

Jonal, How are you coming along?   I hope you do well with your  check up . Will they check  your PSA when they do your Bladder

scan?

  all the best ,

   just me

Hi just me, I am doing really well. I am not as good as you concerning the night time visits or volume passed. I still get up once for 50% of the nights. However, I am so pleased with all other aspects that I would be perfectly happy to continue at this level.

I have my bladder scan and flow test this Wednesday. I want to leave the PSA test for another week or so in order to give my prostate further healing time and for the white cell count to fall further. The reason being that these two factors could affect my PSA level and I want as normal a PSA level as possible because it will become my new base level for monitoring purposes.

I was very surprised that you had a PSA level done so soon after your HOLEP. I say this because the trauma of the surgery can elevate the PSA. Normally after any procedure on the prostate like biopsy etc, they usually allow your prostate some recovery time. I was even more surprised and astonished with your very low PSA result. have you had any follow up PSA tests? I would be interested to know your new base line.

jonal

Hello. I have been following this post for a while. Thank you for your collective wisdom. I do have a few questions. I am in Canada and thus will have to travel. Here are some concerns I have...
1. How long does one have to stay in the city where the operation is performed? I know the hospital stay is only overnight.
2. Do you have to coordinate with a urologist in one's hometown for follow-up?
Does one have to return for regular checks by the surgeon?

I would appreciate your respopnse.
Thanks
Albert

Albert: I'll let others give their opinions but personally I feel that the followup would be best with the surgeon unless your urologist was trained to do HoLep. Though you are only in overnight it can be 3 days to a week or 10 days before the catheter comes out. After that the surgeon - in my case - wanted to see me every six weeks.

So they don't do the surgery in Canada (where I thought you have National Health Insurance)
Steve

Hi Sam: Just curious if you are still considering HoLep at Jeff and who your current urologist is. As I've said, it's certainly an improvement and not taking Flomax any more.
Steve

Albert,

I travelled about 500 miles to have the HOLEP procedure done. My catheter was removed the following morning and I was discharged from the hospital. I stayed in a hotel for one further day just in case of any problems, (but that was my choice) then flew home. The HOLEP surgeon was happy for any follow up to be done by another non specialist urologist in my home town.

Generally the catheter is removed the day after HOLEP. The longer a catheter stays in situ the more possibility of infection. If there are any problems post op these can be dealt with by a non specialist. The specialism for urologists is more in the tissue removal procedure, all other procedures are fairly standard.

I do not have to return for a follow up by the HOLEP surgeon because the procedures are as for a TURP, ie bladder retention and flow tests etc. In fact I have my second follow up with a local urologist this week. This will be to have my first flow test and bladder scan since my op.

I bled and had post op pain for longer than anticipated but was able to communicate with the HOLEP surgeon by e-mail and telephone.

I hope this helps.

jonal

Fantastic. Thank you Jonal. Who was your surgeon? What city? I am still looking.
Albert

Albert, I am in the UK. I don't know if you would want to travel that far.

jonal

Hi recapdoc,

   I thought I would add my comments to your Questions.

My surgeon, Dr Lingeman in Indianapolis Indiana, would have   your lab work done by your Urologist and have it faxed to him. He then meets with you the day before your surgery for a consultation.  The surgery is performed and the catheter is removed the next day. I was discharged after I had urinated twice.  I was given the option to have my followup given by Dr Lingeman or my Urologist. I chose to see Dr Lingeman for both my 6 week and 6 month followup.  I dont have that far to travel .  

My advice to you is , make sure you have an experienced surgeon doing your procedure.  I have yet to hear from anyone who has had this procedure that is not very satisfied with the results. 

At work today, I stood at the stall next to an old friend . I came in after he  had been standing for quite some time. I was in and out.  He was still standing there after I had washed and dried my hands. I sure do remember those days. SO glad it is in the past. Looking back I realize how easy it was remedied and wonder why I didnt have this procedure sooner.

just me

recapdoc

  I dont know what part of Canada you are from  but if you are near Indiana, Dr Lingeman is the most experienced Surgeon doing HOLEP in North America. He is the Dr that brought it here from New Zealand. He has trained the surgeon at Mayo clinic and many other highly regarded hospitals around the country. 

 Mayo is in Rochester Minnesota. if that is closer. I hope this helps.

just me

 

Had HoLep with Dr. Lingeman in Jan. 30th--very good results and recovery.
No incontinence and very little bleeding that cleared up quickly. No pads were ever used.
Dr. Lingemand enucleated 70 grams of a 100 g. prostate. Good volume and no pain peeing.
Dr. Lingeman and staff are excellent.
Best of luck to all.

YOu are doing very well if you had surgery the 30th of Jan with no Blood ,pain, or leaking!  Were you ever in acute retention? I had great results with my surgery ,but Ive been slow in the retention area. My surgery was in late Oct .  As of last week I have only very minor dribbles.  I was in acute retention for nearly 4 months before surgery.  I had to cath twice a day pre Drs orders and when ever necessary .  My journal record 70 times I completely shut down.

I was in retention 2 months prior to the Holep and was self-cath. 5-7 times per day.
It was not any fun.
Now, all is well--good volume; no pain and I do not even have to think about it very much.

Hi Just me and others: Well I met with Dr. Das today. He said flow was great and my bladder empty. He did say it could be 6 months or more till urges stop. We aren't sure if the Myrbetiq is doing anything to stop the urges so I'm going off for a few days or aweek tomorrow. I got some more samples just in case I have to go back on it. He said - that in my case - I don't need to measure my output. I asked him to teach me the Kegel excercises and he suggested I meet with his nurse practitioner to learn. i have appt with her MONDAy.

On a slightly different subject I asked if he learned the surgery technique from Dr. Lingeman. In faxct, he told, me it was the other way around. Dr. Das went to Ndew Zealand - where apparantly it started - and came back and tought it to Dr. Lingeman. This in no ways makes one better than other I just thought I'd share with you.

Dr. Das wants me back to see him in SIX months!