Small Prostate HoLEP - Log

Age 63, 55 gram, large median lobe, high bladder neck, 26 grams removed.

Daily Coumadin (anticoagulant) - for Mechanical Heart Valve

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.

February 8th, 2024: HoLEP Performed.

February 9th
Catheter removed. Returned, 5 hours later with kidney pain and 950 ml 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, 100's of clots came out.

February 12th:
Urine was clear, no blood
Catheter was removed. Returned 5 hours later.
In order to start a stream I was required to bare down hard. I was able to empty my bladder with 20 ml remaining.

I told the doctor about how hard I had to bare down. He was not in favor of a 3rd catheter stating it was most likely swelling, not blood clots causing the difficulty in urinating. He said give it some time.

February 16th:
Required to bare down to start, but nowhere 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 one void.
I am required to do kegels in order to get the remaining urine pumped out, so to speak.

February 18th:
Able to urinate without pushing. There is an obvious start delay at this time, but its progress in the right direction.
I do not have full stream yet. Swelling appears to be subsiding.
On another note; I have a strong desire to itch the perineum, which is another sign of healing / scabbing.

February 19th:
Additional notes; when blood is present in the urine, I get overactive bladder symptoms, the feeling that 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.

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 pass the clots 5 days ago.
So far, the rest of the day has been free of any clots.

February 25th:
Very small amount of blood at the end of a urine stream following the 1st bowel movement of the day.
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.

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

February 27th:
More pink than usual at the end of a stream
Perineum feels swollen. Uncomfortable sitting in a car seat. Couch is ok.

February 28th:
One scab, no pink. Perineum doesn't feel swollen.
Continued urethral spasms for about 20min following an empty bladder.

February 29th: 3 weeks Post-Op
No pink as long as I don't push hard while having a bowl movement
No scabs
Continued urethral spasms - not lasting as long or as intense

March 1st - 5th:
No Pink
Continued urethral spasms - not lasting as long or as intense
Nocturia - Continuing to get up 4- 5 times per night to urinate

March 6th 11:30 a.m:
Delayed urination until Bladder was full. I do not get the pp dance, urgency to go feeling anymore . Just the pressure.
The stream is strong on the first void. Void stops, then requires pushing on the subsequent voids in order to empty the bladder fully.

March 7th 9:00 p.m.
1st experience with retrograde ejaculation.
Forceful ejaculation; burning, throbbing, and cramping from my scrotum back to my rectum.
I could feel the semen shooting back into my bladder.
No blood following the experience.

March 10th 2:00 p.m.
2nd Experience with retrograde ejaculation.
Confirmed retrograde (dry), although it didn't feel like it. No pain, no blood
Orgasm Intensity is about 70-75% of pre-op

Occasional urethra spasms
Occasional Perineum Cramps on left or right side, not at the same time. Occurs mainly on the right side.

Starting a Urine stream is quick and easy. Additional rounds of pushing required in order to empty completely.

March 15th
3rd sexual experience ejaculated about a teaspoon of Semen

Noticing slightly red urine drops only following a bowl movement.
Only notice the red when urine drops landed on the toilet seat.

Urine continues to spray to the right side (makes a mess), similar to poor flowing sprayer nosal,
instead of flowing like an open ended hose.

Occasionally, empty the bladder on the 1st void.
Most of the time, additional rounds of pushing is required to completely empty.

March 20
Urine flow spray is starting to reduce
Urethra spasm have reduced in frequency and intensity
- Spasms are felt anywhere from the base of the scrotum to the tip of the penis

March 21 -- 6 Weeks Post - Op
- Dry ejaculation continues
- Post-op Nocturia... 3 - 6 times per night with 5 being the average - Fluids stopped at 5 pm.
- Pre-op Nocturia..... 3 - 30 times per night. 15 - 120 minutes to void to the point I could resume sleep. 8-10 being the average - Fluids stopped at 3 pm.
- Urethral spasms continue with occasional perineum cramps (assuming overactive bladder)
- resumed very light gym exercise routine.
- 1st void doesn't empty the bladder completely, but I get most of it out.

Thoughts:
The surgery exposed how extreme my urine retention had become over the past 3.5 years.
A prime example would be Feb 9th. A full bladder was normal to me.
I didn't recognize that I had an emergency room issue (950 ml).
I felt pain in my back (kidney), but thought it was gas from the anesthesia.
I have recently tried to let my bladder fill to my Pre-Op levels in an attempt to reduce my over active bladder (nocturia) issues, but I can't get there. It becomes way to uncomfortable for me to hold it that long.
I can easily push on my bladder and not feel like I need to go. Completely, opposite of my pre-op days.

Hopefully, at 12 weeks most of my residual issues will resolve themselves. I intend to update at that time.