HOLEP: Good? Bad? Otherwise?

I’ve been following this blog for about 7 months and have heard a lot about cathing, drugs, and the various BPH procedures including PAE, Rezum, Urolift, TURP, Green Light Laser and HoLEP.  The following summarizes what I’ve read as best I can.

Bottom line:  drugs may work for a while (for me it was about 3 years), but they are not a long term solution and can also result in damage the bladder from constantly being over extended/full.  Some procedures seem to work for some but not all.  Worse yet, some have reported total incontinence after their surgical procedures.  It’s hard to tell if it was a botched job or not.

The real answer imho is surgery, specifically HoLEP.  I did the research on all the procedures (except PAE….had not heard of it), and chose HoLEP.  It is the best surgical procedure because; 1) less time in the hospital and a on catheter (less than 24 hours), 2) less bleeding, 3) very small chance of needing a repeat procedure, and 4) they remove prostate tissue (instead of burning or otherwise destroying it), so they can biopsy it for cancer.  I have heard no reports of anyone having HoLEP and needing a second procedure or experiencing incontinence or needing to continue cathing.  I’ve heard way too many horror stories on this blog about TURP & GL.  My uro explained that they both burn the tissue out, and therefore leave scar tissue.  That tends to shrink over time, and hence the need for a repeat procedure. With HoLEP, they cut the tissue away, grind it up with a ‘morcellator’, push it into the bladder, and then wash it out.

Yes, you the have retro ejac, but sex drive returns, and since I don’t plan to have any more children (age 68), it’s not a problem for me.  I was retaining close to 800ml, and my prostate was 85 grams, PSA 3.8.  After it was 46 grams, PSA 0.2.  I had my surgery in January, and after two to three months had no problems at all.  I did have leakage for 3 or 4 weeks.  Some in the UK report they were told to do Kegel exercises for a few months before surgery to avoid this.

I have heard some good reports on PAE which is done by interventional radiologists.  It is an outpatient procedure and far less invasive.  If I had it to do over again, I might do that first.

Lastly, the experience & ability of the doc is critical, and often difficult to determine.  Hospital ratings for various specialties can be found in the US News & World Report evaluations.  Bios for docs may or may not be available.  For example, the Mayo Clinic was rated best in the nation, and they have the education and publications of their docs listed…… very helpful. Best of luck!

Paul did a good summary, which I agree with. I had HoLEP nearly 2 years ago. There was more hiccups than my over-optimist urologist said, but I'm now mostly good - get up at least once a night, sometimes twice, but less than the 3-5 times before. More importantly, my retention is minimal - 20-50mL v. sometimes over 1L before and causing problems with my ureters.

I too checked out many of the alternatives (but not PAE) and decided HoLEP was best.

Good Morning Bill  Sorry for your problem.  I myself am not a fan of any of the procedures that take anything away from a man ( Retro ).  There are good thing on Holep and bad.  If that is the way you what to go.  With Holep the surgery does help sometimes but it can cause many side effect so your getting rid of one problem for manymore.  Leaking, incontinence some bleeding and retro if you can.  Sometime they get to close and you may not lose your sex drive.  It does not always happen. but it can.  Rezum is new and they have had good thiings with it.  It is not done by a urologist it is done by a radiologist that is why a urologist will not tell you about it.  This procedure will make the prostate smaller with no cutting.  And it perserves your sex life. What ever you do get as much information you can before you pick anything.  Look at the pro and cons.  If you can if you pick Holep have your doctor give you a pill that will cause retro so you can see if you can live with it.  Some men can't because it does not feel the same and stop sex all together.  I can tell you myself.  I was on a pill that cause it. And the orgasm was not as good.  You get the built up and it just goes flat.  Some there is no change but at 61  I am not giving up anything just to pee better.  My orgasm are very intense and I ejaculate more now then I did when I was younger.  I don't care if I am not having kids anymore I still enjoy it And the clean up can be fun for both.  It makes me feel like I'm still alive.  Also I think any man that is having any procedure should watch the video of the procedure and see what is going to be done to them.  Take care and my god help you in your pick Ken ( I had a Uro-lift in 2014 and I'm great )    

Good Morning Bill  Sorry for your problem.  I myself am not a fan of any of the procedures that take anything away from a man ( Retro ).  There are good thing on Holep and bad.  If that is the way you what to go.  With Holep the surgery does help sometimes but it can cause many side effect so your getting rid of one problem for manymore.  Leaking, incontinence some bleeding and retro if you can.  Sometime they get to close and you may not lose your sex drive.  It does not always happen. but it can.  Rezum is new and they have had good thiings with it.  It is not done by a urologist it is done by a radiologist that is why a urologist will not tell you about it.  This procedure will make the prostate smaller with no cutting.  And it perserves your sex life. What ever you do get as much information you can before you pick anything.  Look at the pro and cons.  If you can if you pick Holep have your doctor give you a pill that will cause retro so you can see if you can live with it.  Some men can't because it does not feel the same and stop sex all together.  I can tell you myself.  I was on a pill that cause it. And the orgasm was not as good.  You get the built up and it just goes flat.  Some there is no change but at 61  I am not giving up anything just to pee better.  My orgasm are very intense and I ejaculate more now then I did when I was younger.  I don't care if I am not having kids anymore I still enjoy it And the clean up can be fun for both.  It makes me feel like I'm still alive.  Also I think any man that is having any procedure should watch the video of the procedure and see what is going to be done to them.  Take care and my god help you in your pick Ken ( I had a Uro-lift in 2014 and I'm great )    

Good Morning Bill  Sorry for your problem.  I myself am not a fan of any of the procedures that take anything away from a man ( Retro ).  There are good thing on Holep and bad.  If that is the way you what to go.  With Holep the surgery does help sometimes but it can cause many side effect so your getting rid of one problem for manymore.  Leaking, incontinence some bleeding and retro if you can.  Sometime they get to close and you may not lose your sex drive.  It does not always happen. but it can.  Rezum is new and they have had good thiings with it.  It is not done by a urologist it is done by a radiologist that is why a urologist will not tell you about it.  This procedure will make the prostate smaller with no cutting.  And it perserves your sex life. What ever you do get as much information you can before you pick anything.  Look at the pro and cons.  If you can if you pick Holep have your doctor give you a pill that will cause retro so you can see if you can live with it.  Some men can't because it does not feel the same and stop sex all together.  I can tell you myself.  I was on a pill that cause it. And the orgasm was not as good.  You get the built up and it just goes flat.  Some there is no change but at 61  I am not giving up anything just to pee better.  My orgasm are very intense and I ejaculate more now then I did when I was younger.  I don't care if I am not having kids anymore I still enjoy it And the clean up can be fun for both.  It makes me feel like I'm still alive.  Also I think any man that is having any procedure should watch the video of the procedure and see what is going to be done to them.  Take care and my god help you in your pick Ken ( I had a Uro-lift in 2014 and I'm great )    

I'll share my experience with HoLEP. Keep in mind, your experience might be very different from my experience. I am not going to cover reasons for choosing HoLEP – there is enough information on this site to form an informed opinion.

I am 44 yo. Prostate was intruding into bladder creating flap that severely impeded flow. Bladder was distended, there was a bladder stone.

I had HoLEP at IU Methodist by J.Lingeman on 7/11/2016. 40g of prostatic tissue removed, bladder stone removed, bladder neck resected, tissue pathology was negative.  Out of hospital next day. On elliptical trainer 7/14. Last time seeing anything strange in urine – 7/15. Some discomfort in urethra, managed with phenazopyridine for one day, no narcotics. Swelling around prostate started coming down ~7-10 days after procedure. Sex two weeks later, retrograde ejaculation. At this point, I could not tell you that orgasms, except for being dry, are any different than from the before surgery.

Flow is really good, voiding volumes ~300ml, no issues with incontinence. Can sleep for 4-5 hours, urinate, and go back to sleep. Takes seconds to urinate while it was minutes previously.

According to medical literature, two months is the expected time frame for things to readjust to baseline.