HoLeP in the UK

Posted , 4 users are following.

I decided to start a new thread as older ones get few visitors.

My primary interest is to hear from those who had HoLeP (or Thulium) surgery in the UK.

I'm grateful to those from the USA and other countries who shared their experience, but there are lots of differences in the way the system works in the UK and almost no feedback about local hospitals, NHS or private.

Briefly my background: 50+, 10 years since BPH confirmed, PSA bounces around 10, first retention in 2016, on tamsulosin+dutasteride since then; second retention last year prompted me to accept that surgery is inevitable. MRIs showed no evidence of cancer. Prostate volume was 80cc on the last report with median lobe growing towards the bladder.

I had a consultation with a Rezum specialist, who made me aware that this may not be the best option for me. I am now swaying towards HoLeP because of the short recovery time, prolonged action and relatively low chance of side effects in good hands. UCLH does not have a Thulium laser any more, so private insurance route may be my best bet.

I learned a lot at this forum, however there are several surgeons performing HoLeP in and around London and I'd like to hear from their patients.

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  • Posted

    So, I'll reply to myself. Maybe it will help the others.

    My Holep was done 4 days ago. It was my choice after I decided against Rezum or PAE.

    The night before surgery I emptied the bowel and kept drinking water until leaving home. This was supposed to make the procedure easier to tolerate.

    General anesthesia knocked me out in few minutes. The surgery lasted about 2.5 hours and I recovered after about 4 hours. I was told that I was retaining 600ml of urine.

    The catheter stayed overnight and I felt discomfort but no real pain.

    Post-surgery recovery is played down in the brochures and even in the feedback - be prepared!

    When the catheter was removed - the hell opened.

    An unbearable dull pain from the pubic area spreading to the rectum, a feeling of a stick twisted in your anus. Paracetamol was the only painkiller offered.

    I was able to pass 200ml of bloody urine and it was really painful. I assume this is a muscle pain coming from both sphincters but would like to hear from the doctors.

    In the evening I developed a fever which was initially brushed off by the nurses but when they measured over 38 - they became worried and took a Covid test and a sepsis test. Strangely, I did not feel the fever and thought the temperature was about normal.

    Every visit to the toilet was a torture, many times I leaked and there was a heap of soiled pants by the end of the day. Had the urge every 10-15 minutes.

    Day 2: pain became tolerable and leaks stopped. I could decide when to urinate and did not have to strain the bowel muscles. Temperature went back to normal. Convinced the nurses to take the urine sample for UTI. Was not discharged as planned due to the fever and stayed for an extra night.

    Day 3: the urge came back and the bowels started to open after laxative. Now had to strain , overcome a sharp pain in the urethra and have a bowel movement before the urine could come out. The nurses again tried to convince me that as long as I can pee, everything is normal during recovery. But the pain is going down and there is less blood in the urine. Feeling very weak and drowsy.

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    • Posted

      6 weeks later...

      77g of benign tissue removed, I wonder what the real prostate size was before surgery.

      Bleeding and pain were pretty much gone after the first week.

      The feeling of bowel irritation and bowel obstruction is gone, no explanation given, but welcome side effect.

      Temperature staying below 36 most of the time, getting tired easily and quickly from any activity.

      Libido is zero, erections are weak and ejaculations dry. The last one is unlikely to change, the first two may still improve, though they are not much different from what I experienced on Tamsulosin and Dutasteride.

      Wake up 1-2 times at night, the flow is really good.

      Minor incontinence at times: when coughing, straining or holding the urge.

      Occasional stinging sensation in the muscles from the tip of penis to the anus, usually when straining or when holding the urge.

      Gradually enhancing my diet, avoiding bladder irritants and acid triggering products.

      At the follow up visit Qmax=22 (very good), PVR close to zero (urine level not determinable at the ultrasound).

      In the blood test CRP is normal, but ESR and platelets are elevated, causing me some concern.

      PSA dropped from 9-10 to 0.4.

      Glad it is behind me and a success, aside from erectile function (or disfunction).

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    • Posted

      Thanks Hank!

      To summarise for those considering a BPH surgery: I investigated all options and initially Rezum was my preference.

      Reasons for choosing Holep:

      1. Shortest recovery time (one day with a catheter and pretty much functional after a week);
      2. Longest effective period;
      3. Availability of the experienced surgeons and modern equipment (mine was performed using Moses laser).

        Cons:

      4. RE almost guaranteed (can be avoided by leaving some of the tissue, but there is a risk it will regrow), though for those who have been on Tamsulosin and Dutasteride for years the difference will be minor;
      5. The first day after surgery is the worst one.

      My surgeon performs Rezum, Urolift and Turp as well, but he full-heartedly supported my choice of Holep as the best option.

      Interestingly, in the hospital I was told that prostatectomy was their most popular procedure, though I believe is was more popular among cancer patients.

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    • Posted

      Forgot to add that you should not be suffering from diabetes, asthma, heart diseases and epilepsy, though these will be risk factors for any surgery.

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    • Posted

      Best of luck Hank!

      Let us know once you are through it.

      If I may advise, there are a few things to stock before surgery, unless you rely on your hospital to provide them.

      1. Incontinence pants and pads for 1-2 weeks;
      2. Bed pads;
      3. Medications for bladder spasms/overactive bladders (availability and names vary from country to country);
      4. Mild laxative ( prunes may suffice);
      5. Wipes (either baby or intimate).
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    • Posted

      4 months later - back to normal (as much as possible in pandemic).

      Low libido, weak erections and retro remain, though not much difference from the experience on Tamsulosin+Dutasteride before the surgery.

      I still wear protective pants when away from home for prolonged periods, but this is more for self-confidence than the necessity.

      Usually wake up once at night to visit the toilet, no urge.

      Retro could be avoided by leaving some tissue intact, however, this reduces the procedure efficiency and there is a risk the tissue will regrow in a few years. I definitely did not wish another surgery in an older age.

      I still consider Holep a best procedure for BPH in the hands of an experienced surgeon with a good laser (MOSES in my case). Of the new treatments FLA attracts my attention but there is insufficient information yet.

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