Male 69 HoLEP precedure done this weekend UK

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I'm a 69 year old male who started with enlarged prostate problems, BPH, some 15 years ago and started with the pills some 12 years ago. I started on both tamulosin and dutasteride for 6 months to get the condition under control quickly which they did and then went off the dutasteride for months until the flow rate became so slow that I would go back on both pills for some 6 months until the flow rate improved again and then went off the dutasteride again. I repeated this kind of format until the last year when my prostate had grown to some 70 grams and I need both pills to control my condition. I could have stayed on both pills permamently for better effect but am wary of taking pills in general.

I decided to go the operation route, about 9 months ago, after I had a couple of times where I had not been able to pee and had to take myself off to the hospital for catheterisation and also I was having to get up 3 to 7 times a night for pees. I asked my doctor for a referral to the Freemans at Newcastle who have a good reputation in Urology and have the latest equipment. I was delighted when I was accepted by the Freemans and had my operation this weekend.

The Freemans have been doing the HoLEP procedure for a few years and this is what I was recommended and wanted. I had read about the greenlazer technique which has been going for some 15 years when it was first announced and knew that this was a general improvement on the TURPS procedure. So when I read about the newer HoLEP procedure I was elated that things were being advanced. I am aware that the HoLEP procedure is mainly different from Green Laser because with the green laser it is not possible to do a biopsy to check for cancer whereas with HoLEP a biopsy can be done. There are other differences as well but can't elaborate on these.

I arrived at the hospital at 0700 this saturday and was operated on at about 11am and it took about an hour. I had had a general anaesthesia and found the whole experience very pleasing. The consultant showed me the new laser equiptment which had been used for some 3 months and had replaced the older laser which had been used for some 5 years. I must admit though that when my consultant saw me two hours before the op to discuss my procedure and explain what could go wrong it was a little scary but it is something that has to be said. I was made relaxed by all involved and everything was explained to me at all stages. I was eating toast and drinking tea at 1pm and hardly felt any aftermath of the anaesthesia and felt no pain. I had a catheter installed and drank a cup of liquid per hour and on each catheter bag change the blood in the urine decreased as expected. I spent the night in hospital and had the catheter removed at 7am. A nurse offered me a mix of tramodal, paracetamol and another pill for pain at 11pm which I took even though I had no pain just in case pain set in during the night. I am sure that the pills were not needed because at no point during my stay in the hospital did I have pain and now at 1030 on Monday I am pain free without pain killers. I didn't sleep at night because I was hyper with elation that I had at last got the procedure of my choice and was confident that the op had gone well and would be effective.

So, when the catheter is removed in the morning the hospital need to know if you are able to pee without the catheter and more importantly that one is not retaining any urine after doing your pee. On peeing you press the buzzer for the nurse who brings the scanner to measure what urine residue is left in your your bladder. It took me 21/2 hour to do my first freestyle pee and on scanning my bladder there was over 100 mls of urine. The second pee took another 11/2 hours and the residue was some 70 mls and on my third screen my residue was less than 70 which was consider OK for me being released home. This test is very important because it shows whether the residue is increasing or decreasing and its an increasing residue that builds up during the day to cause one to have to pee through the night. Most people have some residue after peeing. Also it was heartening to see that on each pee the blood staining was less and less. I did fear the the catheter being removed but it was painless and the first few freestyle pees there was a little painful start to the pee but nothing to worry about. I was a little apprehensive about the talk of urine in the pee but it is nothing to worry about at all.

I left the hospital at about 1 30 pm with my partner driving [not allowed to drive for 2 weeks] and arrived home 2 hours later. Still drinking a cup of liquid every hour and was astonished at my new flow rate and start up time. I can never remember peeing with such a force, my flow rate is a least 5 or 6 times better than of late and after years of peeing only about 150 mls I was now peeing some 450 mls. Last night I had my last pee at 11pm and slept until 6am without needing to get up through the night, a first for over ten years. To say I'm elated it is an understatement. I do know that I'm expected to have some blood in my urine for up to 2 weeks but right now it is clear.

In conclusion I am very pleased with this op and cant see any reason why it wont be good going forward for many a year. My doctor made it clear that I would probably have retrograde ejeculation but for me its not a problem because the pills were giving me this condition but my organisms where still good and I'm not wanting children at my age. I did avail myself of all the advice about other procedures on patientinfo ie, staples, ablation, stopping blood supplies etc etc but for me it was a no brainer to get something that is tried and tested and good for a lot of years. Of course its too early to say whether my apparatus will work when really needed but have no doubt it will. But at this stage, I have no dribbles or leakage, I have good flow rate and volume and slept through the night for the first time in over tens years. I also am at this stage in no pain at all and it feels like I've not had an op at all. I'm not saying one procedure is better than another as it depends on many variable, I'm just saying how HoLEP has gone for me at this stage. I will follow up in a few weeks time.

 

1 like, 19 replies

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19 Replies

  • Posted

    I had my HoLEP done in late 2015 and have never regretted it.  Your report was exactly as I experienced other than the fact that although I was offered pain killers I didn't need them and I had a spinal anaesthetic instead of a GA.

    I hope you did the pelvic floor muscle exercises for at least a month before the procedure, as they certainly helped me regain full continence within a couple of days following the procedure.

    As you explained in your very concise report on the HoLEP procedure, the recovered tissue can be sent off to check for PCa which in my case proved positive but as I, my various Uros and GP had all suspected for almost 8 years, I had a low grade tumour which had avoided many biopsy needles and having known it was very likely a pussy cat which I had been living with for almost a decade, the news didn't phase me at all.

    Good luck for a future free of discomfort and the ability to get back to having a normal lifestyle again.

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    • Posted

      Thaks rogcal,  I had read your reports on here which were encouraging. It's a very straight forward procedure and quite positive on getting  a goodlong term result,

      Thanks again. 

      Tony

       

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  • Posted

    Thanks for that Breeze. I am 74 and having HoLEP early in May at St Albans City Hospital. Your report is very encouraging.
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    • Posted

      Hi David, Thanks for your reply, I was pleasantly surprised at how straight forward the procedure was, and it's immediate affect..

      I wish that yours goes well and hopefully hear about it on here. I will report about my progress in a week or two.

      Tony

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  • Posted

    Great stuff Breeze, it was indeed a breeze for you.

    The early result is good and as expected from the Freeman team and I'm sure you will have no future problems from the procedure. It must have been great for you to get a full nights sleep.

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    • Posted

      Hi Derek,

      Thanks and yes it was literally a breeze. The sleep thing is the most important improvement because I was becoming a zombie through lack of proper sleep and was probably a danger driving on the roads. I hope the new May promise of more money into prostate problems address the failure of a lot of regions to address the multitude of people with prostate problems who are too frightened to admit a problem otr too scared to get seen to for all the bad stories about.

      Thanks again for your help and advice during the last 6 months.

      Tony

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    • Posted

      Our local hospital has closed two unneeded wards ?? and is turning them into a modern urology investigation unit. So the message is getting through

      Two wards at the DGH will close soon to make way for a state of the art urology investigation unit.

      Hailsham 2 and 3 wards are to shut in the coming weeks and staff are being consulted about the changes. 

      They could be deployed to other positions within the trust. 

      Hailsham 3 is currently used for patients recovering from surgery and Hailsham 2 has, in recent years, been used as an escalation ward to take in patients during the busy winter period. 

      But health bosses say that with the advancement of surgical techniques, more and more surgery is undertaken as a day case procedure which reduces the need for as many surgical beds and therefore specific wards. 

      The two wards will close and the area they occupy will be redeveloped to locate all urology services at Eastbourne DGH and develop what hospital bosses say will be a “modern, fit for purpose, urology investigation unit. 

      Steve Garnett, a consultant urologist and clinical lead for urology, said, “The new urology area will increase capacity to meet increasing demand and improve the environment for patients. 

      “Eastbourne DGH is the regional centre for pelvic cancer, incontinence and reconstructive surgery and offers patients from across the region an enhanced pathway for renal and ureteric stones. 

      “This is an exciting opportunity to develop our surgical services at Eastbourne DGH with work anticipated to be completed this autumn.” 

      A hospital spokesperson said, “This development will double the capacity of the urology investigation unit enabling many more patients to be treated from the current 7,000 a year. 

      “Clinical rooms will increase from five to 10. 

      “The unit will be able to offer one stop clinics providing patients with a number of investigations preventing repeat visits and speeding up diagnosis.  

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  • Posted

    Thanks for sharing. It is encouraging indeed. I had this procedure done 6 months ago and am very pleased. I did the pelvic floor exercises for some time. During the recovery time I had a stage of incontinence. The doctor said it was part of the healing process and it disappeared completely. The flow rate is good. The doctor mentioned that RE happens in 33% of cases according to statistics. I was accepting that as well mentally and was pleased that it didn’t happen. We are all different and the outcome differs also I assume. Good luck to you and all the ones who doubt about doing a procedure. I think it is well worth for being able to pee and get off medication.
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    • Posted

      Hi emil, Thanks for replying and for the heads up about the possible stage of incontinance. I do expect some sort of set back at some stage but hope not.

      Good luck going forward.

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    • Posted

      I'm surprised your uro said only 33% chance of retro. Mine told me 80% and that it q's pretty.much a given that RE was a result of HOLEP. I wonder if they're doing something different. Are you in the USA?

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    • Posted

      Google, 'freeman hospital holep surgery' and you can get all of their post operative expectations.

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  • Posted

    Thanks for sharing. Why did it take you 2 1/2 hours for the first pee postoperative? Just curious. Hank
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    • Posted

      After having a catheter in post op his bladder would be empty. Post catheter after GL it took me the best part of five hours to pass anything. After my second procedure I was sent home wearing a catheter and the second night after changing the bag before going to bed nothing went into it for several hours. I phoned the contact number thinking there must be clot blocking the tube as had happened on the first day   and they were not concerned  saying it can happen. If it's still empty  in the morning come in. By morning  the bag was filling up again   

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    • Posted

      Hi Hank, 

      It took two and a half hours for the first pee, 2.5 hours which I thought was not too long. I'm sorry if you've read it to be 21 hours. Another guy who had the same procedure took 3.5 hours. I suppose it depends on how well your system is working and how much liquid is in your body once the catheter is removed. We were told to drink a cup of liquid an hour after the operation to ensure a good throughput of urine.

      It took me an hour and a half for the second pee and slightly less  for the third. The hospital didn't seem to be concerned about the amount one pee'd at this stage but only about the amount  retentended. The first pees were not of great volume, but that for me, came once I had got home and into a more relaxed routine.

      Good luck

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    • Posted

      I seem to recall that my first pee I had stood there for a while and it came out with a sudden gush.

      My only complaint about the Freeman was that the ward toilet was not clean with blood and things on the floor.

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    • Posted

      By the way are you taking a stool softener as you don't want to strain for the first two weeks.

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    • Posted

      Hi Derek,

      Yes, I've been taking  LACTULOSE ORAL SOLUTION which works well. I didn't notice any unclean toilets although the bloody urine does stain noticeable.

      I went for my first walk today, only a mile but was surprised at how weak I  was

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    • Posted

      They kept me for a second night as I was still retaining and they suggested that I go for a walk. My wife had been to Gosforth Park Nature reserve the day before and wanted me to see it so we walked to there and round it without any problem.

      I went to the races on day three and felt fine. Everyone was amazed and asked if the operation had been cancelled.  I told them it was hardly an operation as there were no incisions or stitches.

      Day five there a bus strike and I walked about  2 1/2 miles each way to a dermatology appointment at a local hospital.  Strangely the father of one of the nurses had also had GL with excellent results..

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