My HoLEP procedure

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It has been 1 month since HoLEP was performed on me.

73 years old with typical BPH symptoms; nightly pee excursions varied between three to five times a night depending on liquid intake during the day. On some occasions I would experience an extreme urgency to urinate; sometimes it was difficult to get started - but if I was able to lay down and relax it made it easier to start. Taking Cialis 5mg every day helped avoid that situation where it seemed like all the muscles in my pelvic area were tensed up and helped reduce the number of times needing to urinate at night; but not do enough to improve my sleep. Never had to use a catheter to empty my bladder. Whenever my GP did a DRE, they always commented on how large my prostrate was - this went on for 15 years. Cancer was never suspected as my prostrate was smooth and PSA's normal; slight increases over the years to around 2. Never had a UTI or any other bladder/kidney issues.

My prostrate had grown to 158 gm when I finally decided to visit a Urologist this past summer. Did all the standard tests. The Urologist then gave me two options - Simple Prostectomy or HoLEP. He referred me to a Urologist who did HoLEP, when I expressed an interest in doing that. I had one visit with that Urologist and was scheduled for HoLEP. The visit was short - I expressed a desire to be able to sleep during the night with at most one trip to the bathroom; he said he could do that. He gave me a booklet on the procedure, which thoroughly explained the procedure and what to expect after the procedure. He said the procedure would last two hours because of the size and I would spend overnight in the hospital with a catheter in.

During the procedure I was under general anesthesia; it took 2 hours as the Dr. said.

Post-op they were giving me Ibuprofen in case of pain; but I never experienced any. 22 hours after the procedure; the catheter was removed. I did experience major discomfort as the nurse seemingly yanked it out of me - I guess there is no easy way to get it out. While the catheter was in they were flushing out my bladder with saline solution - I lost track of haw many bags I went through - be interesting to see that line item on the bill.

About 30 minutes after the catheter came out I urinated a large amount of blood with small clots; while the catheter was in the saline flush was coming out slightly pink, so I guess the catheter was somewhat preventing the bleeding. After another 4 hours in the hospital drinking lots of water the bleeding became minimal and I was discharged. I experienced major incontinence that first week. This was in the booklet I received before the procedure so I was prepared; had ordered lots of Depends on Amazon.

My discharge instructions were simple - take Keflex antibiotic for 5 days; drink plenty of water; no lifting anything heavier that 10 pounds; and Kegel exercises. The Urologist who did the procedure said to schedule a follow-up visit in three months.

It is now 4 weeks since HoLEP and I am only getting up once a night - even though I am drinking massive amounts of decaffeinated green tea. My flow is phenomenal - I can't remember how long ago it was that it was this easy. Before the procedure I would stand there and go through three start/stop cycles before I could go back to bed. Now it is one and done in less than 5 seconds. And that once a night is probably due to learned behavior from when I had BPH; its kind of automatic for me to wake up and go to the bathroom even though there is no urge to go.

I am now back in the gym doing my HIIT routine and strength training routines; will be playing golf for the first time since the procedure.

I still have minor incontinence; mainly late in the day after getting tired; also if I don't empty the bladder before running water to wash the pots. I fully expect this to resolve with a little more time and my body adjusts to the new reality down there. Before HoLEP my bladder always felt full as the prostrate was pushing against the bladder - as pointed out during my cystoscope. Now I never feel any pressure or really any urgency to go to the bathroom; which is a totally new feeling to me.

The Urologist who did my HoLEP has done many of them; he exudes confidence (almost to the point of being cocky); he is fairly young and was recently appointed as Director of Robotic Surgery at the Hospital where my procedure was performed.

My procedure was a success and has changed my life. Oh and before anyone asks yes I do have retrograde ejaculation - but not an issue for me.

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10 Replies

  • Posted

    of course, if you call incontinence on running water a ”total success”, you have achieved it. so did Derek at his age which is approaching 90. For those younger than 70, the definition of success might be slightly different

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  • Posted

    Hi Kenneth,

    Good for you. Congrats on your success! Only those of us that have achieved success can truly relate to what you have shared. I hope others get the same opportunity to overcome BPH.


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  • Posted


    Very encouraging post. Your pre-HoLEP symptoms are exactly what I am experiencing now. In April I had a bipolar TURP - was in almost total retention at the time. My urologist did a conservative procedure, didn't want me to get incontinence. However, I am now 73, get up 4-5x per night, takes 3 tries to clear my bladder enough to get back to sleep, and still go to the bathroom frequently during the day. So, I am still somewhat blocked. Your statement that you can clear your bladder in one try and it only takes seconds is exactly what I would want if I ever have another procedure.

    Who did your HoLEP and where was it done?

    Also, if you ever have a Foley catheter in you for any reason you can take it out yourself in the shower - just cut the small drain tube, the saline solution leaks out, then you gently slide the Foley out. The nurses just tank and seem to not care about your pain!


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  • Posted

    Kenneth, congratulations! I know how it feels to have an empty bladder, after years of not being able to completely empty the bladder, after urinating. I started having prostate problems, when I was in my early 50's. I am now 71 years old, and will be 72 at the end of the year. I had three turps, and now finally, I'm OK with doing cic. I've been doing cic, for over three years. Do you know if there is a holep doctor in Hawaii? Once again, congratulations!!!

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  • Posted

    yes I do have retrograde ejaculation - but not an issue for me.

    How can it not be an issue? I get it from taking Tamsulosin and a retrograde orgasm is like not having any orgasm at all. So i lay off the meds before the weekend, if i want to have a normal sex life.

    Is it not an issue for you because the retrograde sensation feels alright to you, or is it because you are no longer pursuing sex (no longer a priority) at this point of your life?

    Thanks for any insight you can offer on this . . .

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    • Posted


      for some men RE orgasm feel almost exactly the same as normal. It's a very individual feeling. Orgasm happens in our spine and brain, and semen pushed from vesicles through the seminal ducts just adds a bit to the sensation. Coming through the urethra forward or backwards into the bladder for many men doesn't feel awkward and doesn't decrease the pleasure (which 90% is during the act and interaction with your partner anyway). You partner doesn't feel a difference at all.

      Of course, many things are in our head...

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