2 Weeks Post-HoLEP

Hello Lee

Three of us had the op. on the same day. One went home after 2 nights and one other and I after 4 nights. Unfortunately, the other guy had to be re-catheterised twice and went home with a catheter. Discharge relied on reduced blood content in the catheter bag and retained urine in the bladder following urination after catheter removal.

Voiding frequency has diminished day and night to some degree and, as stated above, there is some leakage. I understand that this is to be expected and full recovery can stretch over several weeks. The main concern of the consultant was to avoid lifting and exertion for at least 2 weeks. Follow-up with him is 3 months from the op.

Not a good recommendation for St Albans compared to the Freeman where Breeze was home next day with no problems.

It would seem that St Albans need to review their procedure. I take it that all three were done by the same surgeon. 

I don't think this reflects on St Albans Hospitals all. Everybody is different. Perhaps St Albans are a little more precautions. 

Hi Derek, 

I've nothing but praise for the Freemans but one of the men having their HoLEP same day as me had a cricket ball size prostate and I don't know if he managed to be released the same day as me as he was a lot slower in doing his retention tests.

Hi david. 

i'm 5 weeks just gone and still really pleased with the op but still having urgency problems which I've read can last up to 12 weeks. They don't happen overnight where I'm only getting up nil or once a night and don't happen when I'm out off house but make sure I go to the bathroom before I get the sudden urge. I'm quite confident that this phase will pass as now some days are getting better than

 others.

good luck going forwards.

I know most people will have RE but ive experienced seminal flow a second time, out of the penis, now so keeping fingers crossed.

Hi breeze

Glad you are progressing well. I am getting up twice a night with no leakage, but during the day if I wait for the urge, there is some leakage. I have noticed that this tends to be more when I have been sitting down, rather than when I have been up and about.

Did you have leakage and, if so, is it still an issue? This is the one thing remaining that I hope will go away. Still some discomfort in the perineum when sitting but this is settling down.

Best wishes.

Hi david, glad you’re progressing well. 

I’m scheduled for Holep June 6 and still deciding if Button Turp is a better choice.  My understanding there is a greater chance of incontinence and RE with Holep. Also Holep is a longer surgery (dont know how much longer), which can mean higher chance of anesthesia risks (dvt, heart attack). 

Not certain but no overnight stay with BT vs Holep. 

I had a large bladder stone (18mm)removed 2.5 years ago and now have six, 1 cm stones. 

I am stressing about this procedure. 

I was kept for a second night at Newcastle as I was not completely voiding and as I lived in Edinburgh then they wanted me to be able to get back to them if I had a problem.

I am surprised that you are still having urgency after five ? weeks.

You might see the other guy at your follow up. 

Quite frankly the two laser procedures I had were no problem. I had my second one a year after having my aortic valve replaced. I had some post op bleeding after the second one that took 3 1/2 hours as I was on warfarin at the time and came home with a catheter in. The warfarin should probably have been stopped a day earlier. I was told that because of my prostate size a spinal would not have lasted long enough.

Anesthesia risks are much less nowadays.

Three results that are less than day surgery or overnight stay would indicate a problem. Would be interesting to hear more results. Try asking for the average stay under freedom of information.

HoLep four nights ? When I was in the cardiac ward most were out in six nights after bypass or heart valve surgery. I was eight days as I had fluid on the lung and had atrial fibrillation and needed a cardioversion. I also needed a supra pubic catheter as they could not get a catheter past my prostate that was even bigger than usual due to prostatitis. 

Hi Phil

Difficult for me to compare with other procedures as my consultant recommended HoLEP from the outset. One advantage appears to be that there is little chance of needing a further procedure in years to come. One of the guys I was in with had a procedure just 2 years before. He wasn't sure what that was, but I suspect it was Turp. He said that he had suffered from leakage over that 2 year period.

A friend of mine had Greenlight laser surgery about 10 years ago and it looks as though he is heading for something else - probably HoLEP.

I read a lot about HoLEP being the "Gold Standard" and am tempted to believe that. I was told that the operation normally took 60 - 90 minutes but mine was nearer 150 minutes, probably due to the size. No problem with anaesthetic and I did not need any painkillers during the 4 nights I was in.

Best of luck with yours.

Hi Derek

I was not at all concerned regarding the length of stay. They explained that the discharge decision was based on the colour of the catheter bag. They are looking for a light rose colour. I would rather that they were cautious and I suspect that they were in no hurry as it was a bank holiday weekend and there were no admissions on the Sunday or Monday. 

 

Yes they like to get patients out before the weekend.

 That was probably why I was discharged with a catheter after my second procedure although they said " You don't want to stay here you might get a hospital acquired infection" ! About three hours later I had to go back as the catheter got blocked by a clot or a scab and it had to be flushed out.

On the Sunday we were out for a walk and I felt my leg wet. We hurried home and I found that the bag was leaking. I told the pharmacy where I got them and they gave me a replacement batch and the makers asked for the rest to be returned to them for inspection.  

"I read a lot about HoLEP being the "Gold Standard"..."

It might be pre-mature to call it the gold standard until it becomes more widely available.  There are still very few urologists doing it in the US.  As I understand it, it requires substantial addition training for doctors only doing TURP (which is still being taught in US medical schools) and similar processes (e.g., Greenlight, button TURP.)  That said, in the hands of an experienced practitioner, Holep has many advantages over the mono-polar TURP as demonstrated in several clinical studies.

Hi David, 

Yes, still have leakage if I can't get to the toilet fast enough. Its a strange situation and like you say seems to be after i've sat down a while. I get a normal type urge but as soon as I stand up the urge is magnified and I've got about 10 seconds to get to the toilet before  I can't hang on any longer. I'm training myself to go when I first get the urge instead of waiting and also hope it will clear up soon. At the second to end of the third week this wasn't such a problem. I'm still over the moon with the op, sleep very well and peeing well with little or no retention at night.

Best wishes to you too. 

ps I ruptured my achilles on monday when I forget to put the handbrake on the car. I saw it rolling slowly down the side street, so dashed off to put the handbrake on when I felt and heard an explosion in my ankle as the tendon ruptered. Needless to say the car came to a stop by itself  a few metres away. So, its about 3 months in plaster and boots.  Ah well!

Sorry to hear of your accident, that is a long time to be in plaster. Had you previously taken Cipro or Fluoroquinolones as they make you prone to future tendon rupture? 

Reminds me of one quiet evening I was waiting to cross the street outside Wimbledon Library at the foot of Wimbledon Hill Road.  A car stops at the lights and a woman gets out and dashes over the road with a letter to put though the Gas Board letter box.  I go to cross and the car starts to slowly move. I look up and there was just a big dog in the front seat. I jump in front of the  car and push against the bonnet to stop it. I shout 'Lady' at the top of my voice and she turns and looks in horror. She runs back jumps into the car and drives off without a word. If it had kept going it would either have hit a car coming from St Georges Road or gone through the windows of Elys department store.

 

 

 

Thanks Derek, Its quite a knock for me but just need to get on with it. The ungrateful woman and i thought you were going to say that you snapped your tendon as well. I did have antibiotic in december and april for the hip and prostate op but nothing since or before. I think i will go the non op route but hope a consultant contacts me soon for a prognosis and repair. I was let out of a and e and told a consultant would contact me. Anyway this is the prostate board so wont go on .

At least your efforts did not lead to a prostate bleed. The first person I know who had GL before me in 2004 used to take groups out deer stalking. His jeep got bogged down and pushing it gave him a massive bleed. This  was just two or three weeks after the procedure.

It is usually Cipro or Fluoroquinolones that Uro's prescribe and the effect on your tendon can start long afterwards as I know to my cost.