Holep Log

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58 Year old Male, 105+ cc gland, PSA ~7. LUTS issues since 50 years old.

Hereditary. Father had same issue at same age and had Turp which resolved all issues and he is happy with it to this day (been 20+ years).

On Alfuzosin + tadalafil since 2022.

Retention and Catheter in 2022 prior to going on Alfuzosin. That was a terrible experience.

2023, Alfuzosin + tadalafil stopped being so effective, came close to retention numerous times so research on more permanent solution begun.

Summer of 2023 had multi-parametric MRI with contrast mostly to try and rule out cancer (had other tests as well not relevant to BPH and they came out clean). MRI came back clean but showed at least 105cc gland with a very large median lobe protruding into the bladder.

Settled on Holep. In my state only one surgeon has done a lot of these but he is like 1 hour drive away. Regardless, I consulted with him in december 2023 and settled on Jan 15 2024 as the date to have the procedure done.

One week before surgery I caught a bad cold and postponed the procedure to Feb 15.

Feb 13, I started having GERD symptoms which I get very infrequently and never last more than a few hours. This time they lasted through to the morning of the procedure.

Anesthesiologist suggested using a tube instead of the mask to protect the lungs from possible aspiration even though I had no nausea just belching and stomach gurgling. I went with her suggestion anyway, it did not seem like a big deal.

Arrived at hospital at 8:15, lots of preop with many people including my surgeon. We discussed possibly only taking out the median lobe if it seemed that would be good enough for me to not have to worry about retention ever again. But, I left it up to his discretion when he was in there performing the initial cytoscopy to decide if that was enough or if he thought it would be better to take out the whole gland. Finally hit the OR at 10:30. Was given something intravenously and next thing I know I am in the post-op room. A bunch of nurses were checking me out head to toe, taking vitals and what not. I checked the time and it was 12:30. Seeing that it was 2 hours later, I concluded that the whole gland had been taken out.

That was confirmed by the doctor a few minutes later when he came to talk to me before he went in for his next procedure.

Went into the overnight room with a catheter in place at around 2:30pm and kept getting checked every 1-2 hours for the next 18 hours or so. During that time, my bladder was irrigated with Saline continuously for 9 hours or so. Output looked clear with intermittent blood mixed in. At midnight they turned off the saline and left it up to my kidneys to provide the liquids.

I was able and allowed to walk around with my saline bags after 2-3 hours of being in that room. I repeated that walk a couple more times.

They put an intermittent inflating device on my calves to prevent DVT.

They also gave me a device to suck air through to re-inflate the lungs, they tend to kind of sag while under anesthesia. I was given tylenol for a headache and miralax twice during this time.

I was also very hungry since I had not eaten for a long time so I ate two meals.

The next morning a team of doctors from my doctor's office came by, checked me out and liked what they saw so they agreed to remove the catheter and perform void trials.

I dreaded the catheter removal as I had a terrible experience with the catheter that the ER had used during my retention days.

This one went completely painless like nothing was even there. I attribute this to the fact there was no prostate tissue to drag on the catheter. In addition, I had no spasms with this catheter while I had continuous spasms with the ER catheter.

The void trials worked but there was a lot of blood. I wasn't ready for that but the nurses seemed unfazed they said that was normal.

Weirdly enough, I got a partial erection while cathetirized, that freaked me out I though it would pull out the baloon but my panic made the erection go away.

I had a 2nd erection when I got home so the good news is that part of the plumbing works still.

Now, the issues, I have random dribbling. I also have blood in the beginning of the stream and at the end.

I also have constipation it seems although prior to the surgery I was very regular (3-5 times/day).

Now the other awesome news. I do not recall ever having a stream that large/wide. And to top it off there's almost no discomfort. On some occasions I may feel a little something at the end of the stream. On a pain scale of 1-10, it's a 1. I will post more as the days go by.

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  • Edited

    Update, no longer constipated. The amount of blood has lessened dramatically. I also seem to be able to hold it much longer before it leaks. Tremendous improvement, only in my most optimistic dreams this would be happening. I also seem to be getting many spontaneous erections for no reason.

  • Posted

    Age 63. 55gm, large median lobe, high bladder neck.

    Urolift in 2021. Complete failure. Median lobe issue not part of the procedure.

    I was, at the time and 2 years later, under the impression that I did not have a median lobe issue. 2nd Uro confirmed large median lobe and high bladder neck Aug 2023.

    Feb 8, 2024 Holep performed. Feb 9 catheter removed. Returned, 5 hours later with kidney pain and 950ml urinary retention. Catheter was inserted and remained in place thru the weekend. The catheter clogged 3 times throughout the weekend. Each time it was unclogged, 100s of clots came out.

    Feb 12, urine was clear, no blood

    Catheter was removed. Returned 5 hours later.

    In order to start a stream I was required to bare down vert hard. I was able to empty my bladder with 20ml remaining.

    i told the doctor about how hard I had to bare down

    He was not in favor of a 3rd catheter. He said it was most likely swelling, not blood clots causing the difficulty in urinating. He said give it some time. Feb 16, still required to bare down to start, but no where near as hard as I did on the 12th. I have a small amount of blood at the point where my bladder is almost empty. I do not empty in 1 void. I am required to do kegels in order to get the remaining urine pumped out, so to speak.

    • Posted

      oh wow. retention is the worst. your gland was half the size of mine. did they take out the whole thing or just the median lobe? was your surgeon well versed in holep? i made sure to find someone who had done many hundreds and i got lucky that the one near me had over 1000 by the time i contacted him.

  • Posted

    My procedure was completed at Mayo, in Jacksonville Florida. The surgeon has completed over 2,000 Holep procedures. The report says they removed 26 gms of tissue, plus the Urolift clips, x4. He stated , 5 days later, that, I now have a wide open channel. The plan was to take out everything.

  • Posted

    26 grams of tissue was sent to pathology. I'm assuming more than 26 grams was removed. Tissue analysis confirmed no cancer.

  • Posted

    Update, 2nd day after the procedure, now at home.

    Yesterday after coming home, I was still able to void normally although I had a lot of stress incontinence and blood at the beginning and end of stream. No discomfort at all.

    Last night I actually had a caffeinated drink before bed time (diet coke) and still only woke up only once to urinate.

    There was no incontinence overnight.

    This morning the urination caused a stinging sensation, the urine must have been 'strong' as I did not drink any water overnight to dilute it.

    Stream is still strong and quick. I do not have to put any effort into urinating. Just relaxing the sphincter is enough for gravity to let everything out.

    My throat is still sore from the intubation and now both sides of my neck are sore.

    I was given an air sucking device to reinflate my lungs so I've been using that a few times per hour.

  • Posted

    Another 2nd day update, I just saw my 1st blood clot.

    Had a strong stream that kinda hicked up for like 1/100 of a second.

    When I looked in the toilet I saw a black thing about 1 inch square. Definitely a clot of some sort. I am happy that it passed

  • Edited

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  • Posted

    Update, beginning of 3rd day. Drunk a lot of fluids before bedtime. Had to get up twice to urinate. Because of the amount of fluids, there was almost no blood. Still, no nighttime incontinence either.

    Constipation is 100% gone, totally back to normal.

    The pain in my neck has subsided and even the scratchy throat feels almost 100% normal now.

    Yesterday I had a bout of lightheadedness and my heart rate dropped into the 40s (48). My usual resting HR is 55-65.

  • Posted

    Update, beginning of day 4.

    I think I regressed a bit. Yesterday I had almost zero blood in urine so in the late afternoon I went for a walk. I walked normal pace. Since I came back the pre and post urine blood is back. I may have overdone it. Other than that, everything else is ok. I drunk about 1 liter of water 1-2 hrs before bedtime and I still only got up to pee 2 times. I would have gotten up 10 times if I had done that pre-op.

  • Posted

    February 8th: Holep procedure

    February 19th :

    Additional notes; when blood is present in the urine, I get overactive bladder, the feeling I need to urinate when I don't.

    I have been walking for the last 4 days on a treadmill ,20 min increments, on a pretty good incline, enough to break a sweat.

    Immediately following the walk, I place an ice pack on my perineum to reduce any inflammation I may have caused from the walk. so far, no increased presence of blood.

  • Posted

    Update, beginning of day 5. Yesterday was a very confusing day. Many changes.

    1st of all I had a lot of blood drops at the end of every urination stream. In some case 12+ drops of actual blood, not just pink urine.

    Middle of the night session, I felt some pain in the perineum area at the beginning and end of stream. It was a dull throbbing pain. On a scale of 1-10, probably a 2 or 3, manageable. It did not happen again.

    This morning's session, the stream was not powerful or 'thick' like the prior days. Disturbingly enough it was almost as thin as pre-op.

  • Posted

    February 8th: Holep Procedure

    February 20th : This morning, I start passing very large blood clots. The good; swelling has reduced enough enabling me to pass the clots. I would not have been able to do this 5 days ago.

    So far, the rest of the day has been free of any clots.

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