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My HoLEP prostatectomy

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ianC
ianC

I thought I'd report whilst things are still fresh in my memory.

Well, I got home this afternoon (Thurs) after the op Tues @ 7 p.m. And things seem to be working OK. No more Tamsulosin needed, so that's one benefit right there. I'll update after a few days as the the other possible effects.

The anaesthetist chose a spinal anaesthetic, which I was somewhat chary of, prefering to be totally knocked out. Later I remembered that there'd been some research that found that older people who had anaesthetics died earlier, so he was right on that score. He also told me that this way I had a smaller number of anaesthetics (general meant 14!, this way 1 to 3).

I didn't like the thought of being awake and watching the op, but he assured me I wouldn't feel a thing; I wouldn't see anything; and I'd be able to feed and drink more or less straight afterward rather than many hours later. And so it came to pass. Just numb legs for a while. I really didn't feel anything. All over in about an hour. I even dozed a bit on the op table.

However, that night (Tues) was not good. I had a constant feeling of wanting to sh*t. However, no matter how hard I tried (and I used two laxative suppositories), virtually nothing happened. I later found out this is a side effect of the somewhat larger catheter and balloon that was put in place.

So I found it hard to sleep. But just when I did doze off once, the nurse came in for the fourth time to take my blood pressure (2.00 am?). I was really upset and told her not to do any more (all the previous ones had been OK anyway). But by then I couldn't get back to sleep. So I was wretched all the next day (yesterday).

However, last night I got to sleep about 8:30 pm; and slept right through to breakfast. Bliss.

The surgeon had come in on Weds; told me about the defecation urge origin; said I could go home today if my urine was pretty clear by then and the catheter had come out. I see him again in a couple of weeks, when the result of the biopsy will be with him. He also said only 10% need the op again in 10 years; most are fixed for good. Here's hoping.

I was apprehensive about the removal of the catheter. In the end though, it wasn't too bad. I did most of it myself, easing it and rotating it a bit when it seemed to stick. Whew! Great. Then I pee'd  a couple of times to test things; told I was OK to go. I left.

Home by 3 pm today. Then did a good walk (4 miles) and all's well. Still some blood and bits, but most clear. Good flow. Now to see how I am at night.

 

2 likes, 171 replies

171 Replies

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  • matt06533
    matt06533 ianC

    Posted

    I had HOLEP surgery on Aug 4, 2015 in San Francisco CA and thought I would relate my experience for whatever it's worth. I'm 67 years old. I had had green laser light surgery in 2008 but my prostate had grown back, larger than ever, and apparently in a mishapen manner. The surgery was supposed to last about 2 hours, under general anaesthesia. I expected to wake up in the recovery room. In fact, I woke up 8 hours after surgery commenced, in the ICU, with a breathing tube down my throat. Apparently the surgery had lasted longer than expected due to  my "humongous" prostate (my doctor's word) and I had developed fluid overload as a result. My doctor was not able to complete the enucleation of all three lobes. I left the hospital the following day with an internal catheter which remained in me for 6 days post-surgery. When the catheter was removed, I found myself 100% incontinent, something I had not been warned about and had not anticipated. My doctor's explanation: because my prostate had been squeezing off the urine flow in the years before the surgery, the sphincter muscle at the bottom of the prostate which controls urine flow had become weak and flabby with disuse and was now unable to stop the urine from dribbling out of me as fast as my body could create it. I was told to perform Kegel exercises to strengthen the sphincter muscle. I had to use an external catheter for several days until the sphincter began functioning a bit, at which point I switched to Depends. I'm now 4 weeks post surgery, still partially incontinent and feeling physically weak and tired much of the day. My doctor assures me that no damage was done to my sphincter muscle during surgery and  is confident I will regain total urinary control over time. He estimates another two months.

         In general, I think I was not prepared for very much of what I have experienced -- not prepared for the fluid overload during surgery, not prepared for the six days of internal catheterization after surgery, certainly not prepared for the incontinence I've had to deal with or the degree I'm still weak and tired 4 weeks after surgery. I relate all this not to discourage anyone from having HOLEP surgery but rather to let those considering it hear about the full range of results and experiences following it.

     

    • bob120
      bob120 matt06533

      Posted

      Matt,

      Thank you for posting. I've found many posters who have had a successful procedure will praise it as an ideal solution, whether it is GL, Holep, Turp, Button Turp, PAE, Uro-lift, etc. And it's understandable they are greatly relieved and happy to share their experience. But it's good to get a balanced view from those who have less than optimal experiences.  

      I heard the similar things from my uro as you did. My prostate was enormous and it grew back at a very fast rate, I had a very large median lobe protruding into the bladder, etc. I wound up having 2GL's and a turp in a little less than 3 years.  

      The original GL was for bph and retention. A year and a half later my second GL was  for uncontrolled heavy bleeding of the prostate causing clots and retention, and removal of bladder stones and resection of the bladder neck. A year and a few months later the 3rd procedure, a standard turp, was for heavy bleeding of the prostate causing clotting and retention. 

      My uro removed about 160 g. on the three procedures, including about 25g. of a 40g. median lobe protruding into my bladder, and says I now have a 40g. prostate with a 15g median lobe. It's been 4 months since my turp and I plan to get a sonogram in another couple of months and then twice a year to see how big it really is and whether it is growing.

      All I can say is that people with very large prostates seem to have the most trouble, and that nothing came off smoothly (no pun intended). 

      Hope your incontinence clears up. I have gotten into the habit of waiting about 30 seconds after peeing to let all the dribbles out,  I can pee well, but definitely pee and feel differently than I did, and I've learned to control the process and only wore depends for about 6 weeks after the turp.

      I'm 69 and don't plan to go through this again. If it happens again I'm having the prostate removed.

    • matt06533
      matt06533 bob120

      Posted

      Bob, Thanks for replying and relating your experience. I too had a very large median lobe protuding into my bladder, so it sounds like our conditions were fairly similar. It's helpful I think to read the range of experiences of others with similar problems. It makes me at least feel less isolated in going through all this.

       

    • frazier53847
      frazier53847 matt06533

      Posted

      LEP or HoLEP is indeed the best procedure especially for volumes more than 30 cc. The reason for slow adoption for this procedure are many which I will attempt to summarize. I am a little solo practice urologist practicing in Charlottesville Va who like many colleagues was frustated with poor outcomes with large prostates. Dr. Montorsi (Milan Italy) presented his experience at UVa in 2010. I was sold and ready to move on having had my share of failures with every other technology including bipolar, button, Green-Light. That is just in the last 10 years, started in 1990.

      First problem is learning since the laser stablizing catheter is so different than TURP. More importantly is the availability of the technology. Lumenis was the only company offfering the scopes, 100w Holmium and the morcellator. Very few reps available to call with this equipment so why bother right? Equipment is expensive and hospitals are reluctant to make the investment on unproven technology. So I tried one case and waited for better options. Meanwhile I was self-teaching with the button enucleation and TURP the rolled up tissue.

      Then Darrell Shires from R Wolf came to me talking about an informal marriage between Richard Wolf and Convergent Laser (Pro Touch). Richard Wolf which is a German company (Europe has moved to HoLEP by the way). They have the best laser scope and best morcellator. So I gave this a try with the Convergent Pro Touch Laser. Same 550 micron laser fiber as HoLEP but seals blood vessels much better than Holmium. I liken it to a Prince racket vs a Jack Kramer. Both are great but the Convergent just makes it easier to learn.

      So take heart, we are responding to you and want to do the best job. I hated revisions after TURP or Green Light. I don't worry about that anymore.

      Most folks go home same day with catherter for 2 days. Minimal bleeding. No limit on volume really.

      Regarding complications: Short term stress leakage risk is higher than TURP which is logical. We are removing all of the adenoma. Long term > 3 mo leakage risk is same as TURP. Urge incontinence is really independent of the procedure. Fluid absorption is also an issue. My hospipal put a 2.5 liter fluid absorption ceiling because of that concern when I started coincidentally because of some Gyn procedure complications. The key is to avoid capsular perforation. Need to recognize the capsule and keep power down. It helps with some experience.

      Encourage you to look at these other alternatives. Great time to have a large prostate. Ha! I have posted video but they aren't public. I may be able to send the link but they aren't heavily produced and purpose of the post is not to self promote.

      FF

    • mal7896
      mal7896 frazier53847

      Posted

      Thanks for the interesting post Frazier.

      Do you consider thuLEP as effective and successful as hoLEP?  The reason I ask is no urologist that I'm aware of where I live  does the hoLEP procedure....but there is a urologist here who performs thuLEP

      Mal

    • frazier53847
      frazier53847 mal7896

      Posted

      Great question. This is what we are likely to see more of as there are more LEP procedures being performed. I have not used Thulium and pure anecdotal gossip is that it bleeds more than ProTouch although these comments are likely more related to these Thulium vaporesections (I think). Uggh!

      If he can Enucleate, yes I think that your outcome should be similar to other enucleations. The key is getting to the capsule and staying there. However he can control bleeding effectively is fine. I like the Pro Touch but admittedly access to that technology may not be available yet.

      Fact is that much of an endoscopic enucleation is done bluntly without any laser energy.

    • lester90053
      lester90053 frazier53847

      Posted

      It is unusual for a urologist to comment on these posts. Some of the horror stories I have read here make me sick and I have to stop reading them.

      Since we are all anonymous, perhaps you can comment on some of the information I cannot get from my urologists.

      4 years ago I had Green Light. I was age 84 then. It took me almost a year to fully recover and I was fine until 6 months ago when I was involved in an auto accident. The trauma may have caused retention to recur and I have been wearing a catheter ever since. My urologists tell me that it is possible that the problem could eventually cure itself and once a month when I change catheters, I remove the old catheter and wait 9 hours before the new catheter is inserted. During this time I am able see if there is any improvement. Over the past 3 months there is a slight improvement which seems to get a little better each time.

      My urologists have suggested that I now do TURP. Given my age and previous experience with GL, I hesitate to do so. I have been researching HoLEP but my urologists are not interested although there a few other doctors in nearby areas that do it. I would like to hear your thoughts. Thank you.

    • frazier53847
      frazier53847 lester90053

      Posted

      Without knowing your specifics, I can give you a general impression. The age of 88 is not necessarily a disqualifier in my view especially in someone who is stuck with a catheter. The question of comorbidities associated with age 88 of course have to be considered when looking at the risk. Anticoagulation with Coumadin or aspirin therapy are not disqualifiers with HoLEP. It would really depend on whether there was confirmed obstruction remaining and confirming that the bladder contracted sufficiently with testing (urodynamics). Another consideration is whether there is any denervation to the pelvis from your accident. Confirming good pelvic tone would predict good sphincter tone. Otherwise, I think that it is a terrible burden to have that catheter.

      The reason I posted initially is to make sure that those like yourself who are interested in this procedure understand that equipment availability in this country has been limited to 1 company (until recently)with considerable expense to the hospital. Considering there is a learning curve and alternative technologies available, that somewhat explains the sluggish adoption of this procedure. No doubt though it will make its way into every residency training program which will effect what is offered in the community.

    • tom86211
      tom86211 matt06533

      Posted

      Matt,

      In your post you said that you had your HOLEP performed in San Francisco last August. Where did you have the operation done and by whom? I thought the Mayo Clinic in Phoenix was the only location close to California where HOLEP was available?

      Thanks, Tom

    • revbkelly
      revbkelly frazier53847

      Posted

      Hi Sorry to bother you, but I have been following this discussion.  I just had Green light laser therapy.  Some people say that HOLEP is better than green light because it is more of a permanent sollution.  Now I am concerned that I will have to have more surgery.  Do you have any comments on this or can you point me to any research, books that talk about these issues?

      thanks!

      Bill

    • bob120
      bob120 revbkelly

      Posted

      I think it may depend on the size of your prostate and other factors. I had a GL in June 2012, a second one due to bleeding and bladder stones in Dec 2013, and a TURP in June 2015, due to bleeding. The TURP seemed to work the best and I have been taking dutrasteride since Nov. 2015 to keep the prostate from regrowing. I was told I had a128g. prostate before the first GL and a 300g. prostate before the second GL and 305G before the TURP. My prostate was measured with a sonogram at 205g. after the TURP and 235G. in Nov 2016. I'm hoping the dutasteride keeps it from getting back to 300G and causing another bleeding episode. All three surgeries improved my stream, but none solved getting up 3 to 4 times a night.

  • paul20443
    paul20443 ianC

    Posted

    First of all, thanks to everyone who has posted here..... it has been a great source of information to add to the research I did prior to my prostate procedure.  Last year I belonged to an HMO and had a great uro, but he only really talked about TURP, and then talking to others and searching the internet, I found there were many more possibilities.  I settled on the HoLep procedure for the following reasons: 1) less time in the hospital (1 day compared to 3 or 4), 2) less time with a catheter, 3) less blood loss, and 4) lower likelyhood of needing a repeat procedure.  Since my 2nd home is here in the Phoenix area, I settled on getting it done at Mayo.  It was great to visit their website and see the write up on all their uros, including their education and publications.  Dr. Humphreys stood out head and shoulders.  When I called for an appointment they first said I could see two other guys, but I said no, I wanted Dr H.  I was put on hold for a few moments and they came back and said OK.  Had it done in January.  In and out of the hospital (sans catheter) in less than 24 hours.  Because they biopsy the material they remove, they detected a minute amount of cancer, which will need watching over the next few years.  The whole Mayo experience was very impressive.  Also, looking for some independent review of Mayo, I found a US News &  World Report evaluation of almost 5,000 hospitals in the US (looking at over a dozen specialties).  Mayo was #1.  Even though some of the cost is out of pocket for me, I'll be back for anything significant in the future.  Last year I had a procedure at a hospital in Washington state...... had I seen the US News report on that place I would have gone somewhere else.  Do your research!
  • Motoman
    Motoman ianC

    Posted

    Can anyone comment as to the cost of this procedure, and whether it is covered by insurance? 

    I tried contacting Mayo about it, you have to come in person for a review before they will tell you anything about whether you are a candidate or not. I'm 1500 miles away from a clinic, so not that practical, when I have been approved for PAE and TURP already. Turns out I am not a good candidate for PAE due to atonic bladder. I have been researching new ITind procedure, and was ready to have that done, but the Urologist thought Holep might be better with my bladder situation. But thought either would work, just that Holep might be better long term.

    • ianC
      ianC Motoman

      Posted

      Mine was in the UK and cost about £5K = $7.5K. I could have had it on the UK's 'insurance' (=NHS = Obamacare?) but the wait may have been months.

      Whilst my HoLEP had some post-op issues longer than promised (like 15 months of haematuria and leukocytes), I'm now fine and generally don't have to get up at night.

    • paul20443
      paul20443 Motoman

      Posted

      I had HoLEP done at Mayo here in Phoenix 3 months ago, and it went very well.  After researching all the options, I chose HoLEP because 1) the hospital stay & catheterization is a day or less; 2) there's less chance of needing a repeat procedure compared to TURP; 3) recovery is shorter, and 4) they biopsy the tissue removed during the process.  I insisted on Dr. Humphreys as he is the most experienced guy there.  Since most of the pre-op testing is not rocket science, you might ask Mayo if that can be done elsewhere and the results sent in.  They want a cystoscopy, an ultrasound measurement of the prostate size, and a test to measure the retained liquid in the bladder after you void.  The surgery cost me about $2K out of pocket after medicare and my other insurance, but well worth it.  Mayo is rated #1 in the country by the US News & World report on most all American hospitals.  I was very impressed.  Best of  luck!
    • Motoman
      Motoman paul20443

      Posted

      Thank you. Tried Mayo, couldn't get past the gatekeeper on the phone call. Have already had all those tests done. Can get the procedure done overseas, but I'm sure insurance won't pay for it, but don't have to wait or jump through all the hoops either. I have a high deductible, which is why I ask cost. It may be cheaper and faster to just travel, since my insurance won't kick in until the $7000 deductible is met. 
    • lester90053
      lester90053 Motoman

      Posted

      I too have researched ITind and I am convinced that it is a hoax.
    • bob120
      bob120 lester90053

      Posted

      The one study on ITind said that  that the mean prostate volume of the 132 patients in the trial was 29ml, and they didn't use the procedure on anyone with a prostate over 60ml. Even if it did work, that is not a great cross section of people with bph.
    • Motoman
      Motoman lester90053

      Posted

      Why do you say it is a hoax? I have seen 2 studies that show good results. They are doing clinical trials in the USA now. The Dr I spoke with has done it twice with positive results. He just wasn't sure how long it would last. But thought it would be a good first step if I didn't want to go all the way to Holep and RE issues.
    • bob120
      bob120 Motoman

      Posted

      Motoman, see my post above to lester.
    • Motoman
      Motoman bob120

      Posted

      I saw that. I am just curious why he thinks it is a hoax? My prostate size was measured at 36 grams, so not huge. A well respected urologist has said he thinks ITind will work, but that Holep would be better based on my circumstances. I'm going to make a decision one way or the other. Holep seems to be more of a sure thing, but has some drawbacks like retrograde ejaculation. The ITind seems to have the drawback of not a large group of data, unknown length it will last, and having the device implanted for 5 days. Sounds like it is uncomfortable. And the Holep procedure might have me healed up in that amount of time.

      But, it the ITind doesn't work, I can always get the Holep later. It is a tough decision, but I have to do something. I am using catheters at times, and that sucks. More so when you don't know when you need them.

    • lester90053
      lester90053 Motoman

      Posted

      The iTind is supposedly a contraption that is inserted into the prostate canal through a cystoscope and then removed the same way 5 days later at which time the patient is supposedly cured of BPH. This may be a reality 50 years in the future but if you told this to a urologist today they would tell you they might as well look for another profession.
    • bob120
      bob120 Motoman

      Posted

      The ITind apparently covers the area of both the prostate and the bladder neck which is good. My question would be if you also have a median lobe problem. All three areas can cause retention. My first GL laser only adressed the prostate. My second GL reseted the bladder neck. My third procedure, a turp addressed the median lobe. Your prostate is quite small, so it would seem any procedure ought to work for you. My prostate was more than 120G before the first GL, and was 300g. before the third procedure, a turp. Presently it is 203 g. and I have been taking dutasteride for the past 4 months to try to shrink it, or atleast stop it from growing. Yet my stream and PVR (post void residual) are both excellent. The whole bph prostate issue isn't as cut and dried for everyone as they make it seem.
    • Motoman
      Motoman bob120

      Posted

      Bob, 

      thats why I think it is a tough decision. ITind might work for me and is less invasive, but I have other issues, and it would be nice to get them all taken care of at once. I have to travel no matter what, unless I go for TURP, which I don't want to do. I found a very qualified Uro who will do either ITind or Holep, but has done thousands of Holep.  He thinks that is a slam dunk, but it has other issues. I'm 53, so not sure I want to live with the negatives of Holep at this time. But I am leaning that way to be one and done. 

      Thanks for the replies, it helps.

    • bob120
      bob120 Motoman

      Posted

      Many people have negative feelings about the retro ejaculation. I am one of those who really had no problem with it. Other than that I think the smaller your prostate is, the faster you recover from a surgical prostate procedure.

      Hopefully you are not taking blodd thinners. I had two hematurias that promtpted my second GL and Turp. I wasn't on blood thinners but most of the men in the ward that had prostate hematuras were. Good luck.

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