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, day 6. Got up 3 times last night. 1am, 3am,7am. (I still drink quite a bit from 9pm-12am, about 0.75-1 liter)The 3am session, I had quite a bit of blood coming out, the other 2 times, minimal. At the end of each session now I have the same dull pain I would experience pre-op if I held my pee in for too long. Not sure if it's sphincter or bladder that cause that ache. It's not a strong pain and it dissipates almost immediately.

    One other change is that my urine does not smell like blood anymore, it's starting to smell more like urine.

  • Edited

    If you do not have urinary incontinence/leakage/urgency after your surgery, it should be successful.

    • Posted

      I had all 3. They have all gotten better but are still happening. I have not seen any testimonials of people having zero incontinence after holep. Everyone seems to get some but at varying degrees.

    • Posted

      I've not had incontinence after or before the Holep procedure. I believe this is due to my small prostate size,55 grams, and high bladder neck. 18 days post op, no incontinence.

  • Edited

    Update, Day 8. Not much has changed, still peeing blood before the stream starts.

    Still dripping randomly.

    The stream has gotten even larger, about the width of my pinky. I can empty my bladder in 2-3 seconds.

    Amazing really, I don't think I peed that well even when I was 20. Maybe I had a large prostate all along.

    On another good note, the prostate pathology came back clean, no sign of cancer which is a huge relief. The note said the pathologist got 2 cups, 78 grams worth of tissue.

    On a bad note, I got a note from my insurance that they do not want to pay for my overnight stay because they say it wasn't medically necessary. I will let the hospital+doctor fight it out with them 😃

  • Posted

    Day 9, did not start good, peeing fine but I get a good chunk of blood at the end of the stream. Not urine with blood but blood.

  • Posted

    February 8th: Holep Procedure

    February 25th:

    Vary small amount of blood at the end of urine stream after pushing for 1st bowel movement. No blood for subsequent bowel movements.

    I get up 4-5 times a night to go to the bathroom. I believe this is due to the fact I'm drinking water up to the time I go to bed.

    I have a lingering spasm/ feeling in my urethra to go to the bathroom after I empty my bladder. Subsides after 20 minutes.

  • Posted

    February 8th: Holep Procedure

    February 26th : Starting to see tiny scabs. No pink colored urin, so far.

  • Posted

    Day 10. Very confusing.

    Flowing large stream, very little blood at beginning of stream no blood at the end. Very little leakage/incontinence.

    At least, that's how it was for most of the day. By end of day, I had lots of blood at beginning of stream and a few drops at the end. At least the incontinence is almost gone. I only got some after some slightly strenuous activity.

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