Another HoLEP Experience in progress
Posted , 13 users are following.
Got a lot of good info off this site, so time to give back.
I have BPH issues of weak stream and an incident of acute urinary retention with a trip to the ER, along with a bunch of almost visits to the ER. I also have prostate cancer, G3+3=6. I am doing surveillance of the cancer, and chose HoLEP to resolve the BPH and to make me suitable for radiation treatment for the cancer if needed. Prostate size is 140cc. Well, it was 140.
Had the HoLEP on Monday, and it is Thursday. Stayed overnight while they ran a 55 gallon drum of saline through the bladder, released next morning after successful void trial. Successful but messy, I'll mention. The surgery was under general anesthesia, 2.5 hours.
Used pullups the last two nights to catch dribbles, and pads during the day. Very little pain at all. Continence rapidly coming back, although I have to think about it.
Will update with progress and answer questions. So far so good.
9 likes, 25 replies
mike81026
Edited
Friday morning, made it through the night with what appears to be zero leakage or stress incontinence. Kind of sore down there, which I assume is "healing soreness" as the body fixes itself. Flow has been clear for last 16 hours or so. All good!
Mavrick mike81026
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Mike, good report. Thank you! Who was your surgeon? Much appreciation!
Mav
mike81026 Mavrick
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Dr. Knoedler at Hershey. Gets a thumbs up so far.
Day 5, urine is clear, maybe a wee bit of occasional red. Pad is dry at end of day, but a few red stains as the innards heal. Got maybe a little constipated, leading to some discomfort Down There? Listen when the docs recommend eating your fruits and veggies for a while. Even its two different body systems, they are close neighbors and talk over the fence, so to speak.
Urinating is a gushing flow of joyful noise, then you get an odd ache at the end, and maybe some feeling of urgency (have to again). Just ignore that.
Havent treated for pain at all, other than beer. Been adhering to the "nothing less than 10 lbs" rule although i absolutely feel like I could get back to full activity.
You think its your heart or the brain that is in charge until your prostate weighs in.
Mavrick mike81026
Posted
Mike, thank you so very much for letting me know about your surgeon. Really hope your improvement is permanent. I have an unusual case of blockage with a small prostate and am looking for a Holep surgeon with 500-1000 successful past procedures. Much appreciation. Mav
mike81026
Edited
A full week from surgery. Flow is awesome, some post-void pain that is likely a bit of bladder spasm from my angry plumbing, no biggie. Some generic healing soreness down there, all tolerable. Been eating fruits and veggies mostly, or at least a lot more than I normally do.
Continence seems to be 99% now. I'll get a surge of stress incontinence when I stand up out of bed in the morning, but I just Kegel that back into line and get into the bathroom, and the let it flow. It's so fast, I worry about frictional heating. Woot!
I had a twice-a-day antibiotic starting a week before the procedure and I will take them until the end of next week, so three weeks total. They also gave me Ampicillin during the surgery and another dose that night. No signs of infection, which is good.
My father had a TURP last summer, and came down with an infection about two weeks out that put him in the hospital for 4 nights, so I am wary.
mike81026
Edited
Two weeks out, and I've ditched the pads. Some stress urinary incontinence feelings when standing up particularly after laying down, but it passes. Still some soreness sensation Down Thereabouts, but nothing painful. Flow is awesome. No blood in urine.
Spoke with Uro about activities, and whether I could swim based on status. He said I could, so I went paddle boarding. Didn't fall in, so no immersion. Most sites mention 4 weeks before bathing or swimming. I'm not rushing it.
mike81026
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Coming up on 4 weeks out, pretty much totally continent. Still need to remember that i had some serious surgery Down There and not take continence for granted without thought.
Get a brief odd pain at the end of each urination event, kind of like a bladder spasm? Not bad, and the flow rate is very high, so its well worth it.
On a rare occasion will pass a small clot or material, otherwise a clean stream. No blood.
Sexually, things work fine, but its 100% retrograde. I dont care.
I plan to get back on the bike for the first time this weekend, will be curious to see if that generates some clots or odd pain. Otherwise ive been working out and lifting heavy things for two weeks.
Pathology came back, had a hint of atypical cells in a small region also showing crush and cautery damage, i.e., at the edge of the removed material. This was expected, as I have G6 cancer in a small lesion on the periphery, which appears to have been sampled. The good news is the rest of the material is clean.
mike81026
Posted
Latest,, enjoying a bout with urge incontinence coupled with what I believe are bladder spasms. the urge comes in fast, and I've had to struggle to make it to a bathroom a few times. This seems to correlate with drinking lots of sodas (caffeine) and beers (alcohol) which is known to aggravate the bladder. The spasm at the end of urinating feels like my bladder is trying to empty when it is already empty. Lasts for a few seconds.
Cut the beers and cola to see if that improves it. Havent called the doctor yet. I expect this to pass, am just sharing for anyone else walking the same path.
Flow remains crazy strong, and otherwise am fine. long bike rides, sex, hard workouts, etc.
mike81026
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90 day update.
Saw my Uro, he is happy with everything and I mostly am. I pee like a racehorse, zero threat of retention. No pain, nor has there been pain down there for a month or so. Except...I've been wrestling with OAB, and when you get the spasm, at the end of urinating I'd get goosebumps and some minor discomfort. Don't even want to call it pain. Other than that, good to go. About two weeks ago, the goosebumps stopped and the urge is decreasing. Not gone, but decreasing. I'm hoping it continues to improve fast.
I was diagnosed with Gleason 3+3=6 cancer before the HoLEP, with a PSA of 5.10. Just had my post-HoLEP PSA, and it fell all the way to 0.4, which is great. Hoping it stays low.
mike81026
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Latest update, now almost 4 months, the overactive bladder is gone and all systems are go, I'm glad to say. No leftover side effects, so all good. Glad I had the procedure for sure.
george60457 mike81026
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Hi Mike,
Thank you for all of your Great information. I'm going to U of M. in Arbor next month for a consultation to see if I'm a candidate for the HOLEP. My prostate is 178 with a Gleason of 3+3. If I have the procedure I hope that my results are as positive as yours. Thanks again. George
mike81026 george60457
Posted
George, hope your visit went well. Let us know how it goes. Maybe start a thread?
Still super happy with my results.
adam74032 mike81026
Edited
Just had a Holep yesterday. Came in with a catheter, so semi-urgent situation.
Too early for eval. Maybe 10 ml's blood at start of micturition, then clear. 97 gram prostate, 66 grams of removed material. Small bladder with some thickening, but not severe.
Urine flows well, just monitoring bleeding for now. Given Bactrim and Solifenicen to relax bladder.
compiler adam74032
Posted
The HoLEP has a very low prostate reoccurrence rate. Has the post-surgical examination for cancer by a pathologist done? How much time did the surgery take?
adam74032 compiler
Posted
Good questions. Surgery took 110 minutes, which is a bit on the long side, but there was apparently quite a bit of cauterization, and the resident was doing some of the work (they are slower, of course).
Waiting with fingers crossed for pathology results.
Eight days out, and the bleeding has mostly stopped. Discomfort on urination slowly resolving. Remarkably little real pain. Urinary flow is strong.
Over the next weeks and months, there is a risk of urethral stricture or bladder neck contracture, both of which are basically the build-up of scar tissue which blocks urine flow.
compiler adam74032
Posted
Has the bleeding stopped? I saw a guy reporting still having light blood after one month. Another guy found has PSA decreased many after the HoLEP.
Motoman adam74032
Posted
Hello, where did you have this procedure done? I am scheduled this month at Mayo in PHX. You only had a catheter in overnight and everything was good after that?
adam74032 Motoman
Posted
I think you're in very good hands. Yes, I had catheter overnight, but I came in with a catheter, which I had had for 9 days. So far, no problems. A clot and small amount of blood here and there after 11 days. Been doing a bit of physical work, but not lifting anything too heavy.
adam74032
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Now 18 days out from Holep. Tissue came back as benign! No more bleeding. Still a bit of stinging on urination. Strong flow.
compiler adam74032
Posted
Good results. You do not need to worry about the prostate any more but just do the regular PSA. The downside probably is the retrograde ejaculation. Please report back if you don't mind.
Motoman adam74032
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I had a Holep on 3/21. It went great, and had the catheter removed the next morning. I peed great after catheter removal, with only 20 cc of retention. Much better than before the procedure. I am now a week out, and peeing like I did when I was 20. Pain was minimal all along, I have not taken any pain pills. A bit of bleeding here and there, thats it.
I had previously had an Itind procedure in 2016, FLA In 2017, and a Mini Turp in 2022. So i have done a few minimally invasive procedures, knowing I could get more aggressive if needed. All of those procedures worked great for a while, so I am cautiously optimistic this one works better than the previous ones. Feels better so far.
adam74032 compiler
Edited
5 weeks. Strong flow. Very little burning. Still some very fine material in urine. Retrograde, but doesn't bother me in the least.