Benign prostatic hyperplasia (BPH) Surgery Options

March 27
Nocturia
Rough night, stopped fluids and food at 3:30pm. NO snack or salt before bed
Urinating like a horse every 30 min.or sooner. This went on for 2-3 hours.
After falling asleep, I was up an additional 3 times.
For me, salt definitely reduces my night time bathroom trips.

March 28 & 29
Nocturia
In my failed search for a low dosage salt table, around 100mg, I ran across Cell Salt tablets.
They are small and melt under your tongue.
The tablet contains 12 different Cell Salts in 1 tablet.

Stopped fluids and food around 4pm.
10pm, I placed 2 cell salts under my tongue and went to bed
Up 2 times each night instead of my usual 5.
The cell salts appear to contain enough salt reduce my night time bathroom trips.

April 4 - 8 weeks post-op
No visible signs of blood since March 31

Urine flow sprays if my bladder is not full and streams when very full.

Stopped, Cell Salts, April 1st. They increased the time to start a stream to around 30 seconds on my night time bathroom trips.
The cell salts contained antihistamines and pain relievers.
I believe the pain reliever helped reduce the trips to the bathroom and the antihistamine caused the delay in starting a stream.
Taking ibuprofen before bed is a common practice to reduce your bathroom trips, but it’s hard on your liver.

April 4 - 8 weeks post-op

Incorporating more red meat, instead of chicken, for the taurine and B vitamins.
Results:
- 4 hamburgers in one day, up 2 times that night
- 1 hamburger the next day, up 3 times on that night.

Short bouts of depression, around the 7 week post-op time frame, thru April 3.
I can definitely tell that my body is going thru some chemistry changes.
The depression may be my body reverting from a sympathetic (3 yrs of fight or flight) mode to a parasympathetic (rest and digest) mode.

I have successfully confused myself. After a cystoscopy, my doctor indicated the the median lobe was causing the BPH issues. He said I had three options: a) green laser, b) HoLop, or c) bipolar. He wants to cut out just a part of the median lobe. He said the HoLep would be overkill because it would enucleate the prostate, and that is too much given I have prostate cancer and will need treatment down the line. He recommended bipolar.

But I'm confused, can't the HoLep also just cut out the median lobe parts that are interfering?

May 2, 2024 I had the HoLEP laser prostate enucleation.
HoLEP under general anesthesia using propofol and rocuronium (off-shoot of succinocholine paralytic agent), and gas- unknown.
61 year-old male. I was able to sleep only four hours the night before, but the tiredness worked in my favor. I am in Barcelona Spain, living alone after divorce, death of my mother in the USA. Fight or flight mode with feelings of loss, despair, hopelessness, wearing a catheter since 2022.
High cortisol levels causing anxiety, fatigue, malaise. Catheter provoking neurosis about health, chronic UTI-related thought changes adding up to an unhealthy bio-feedback chain, combined with the bi-monthly trauma and stigma of catheterization and limited movement from catheter sensitivity.

Day of surgery post op- confined to bed in the hospital. Given Augmentin 1,000 mg parenteral antibiotic I.V. Tid.
I asked for the HoLEP, well, demanded it, since they were steering me toward TURP, in which case might end up returning after regrowth (my prostate had tripled in size over a year) and the prospect of blood transfusion which I didn't want, and the mRNA artificially produced immune response to what I will be censored for mentioning. I auto-donated after debate, they finally capitulated. No transfusion needed during the operation.

HoLEP procedure for a 105 cc prostate size I was told was 1 hour and the outcome, satisfactory. Followup review with the surgeon and discussion about any pathologies found, if any, from the prostate cytology June 3, 2024. Post-op: I was given no specific instructions in writing or verbally regarding activity, but I have read about lifting anything over 20 lbs. I was prescribed oral Augmentin 500 / 125 p.o. Tid 7 days + Ibuprofen 600mg p.o. Tid 3 days only.

May 3
Continued bed rest with three-way Foley f33 with continuous bladder irrigation running almost clear, like rosé wine. By mid-morning, normal light yellow. No particular pain, except for the familiar occasional spasm from the catheter. Flank pain and headache I both attributed to the Augmentin and the surgery. A slight ache in the perineum, but not enough to ask for medication, only for the headache. I had not had a bowel movement before the surgery (nerves) and with the general anesthesia, constipated with little disturbance if any, from the Augmentin antibiotic. I drank water to try to re-hydrate myself and asked for light food, yogurt, soups, etc. even though this was not suggested, when I had a menu in hand, I opted toward less solids and NO COFFEE especially with the antibiotic, I didn't want any anxiety.
10 a.m.
Adjunct doctor came in to inform me that the catheter will be removed (based on the color returning to normal) and to test if I could urinate on my own after drinking water.
Noon
They removed the catheter, which I was unknowingly bypassing overnight while attempting many times to fart.
I commenced drinking more water I poured from a 1 liter measuring cup to track intake vs output (IO's).
I began with dribbles with darker blood, some patches of loosely coagulated blood solids. Three tries to make 100cc. With each try, I produced more volume of urine with a stronger flow. 50cc, 100cc, 150cc, some lighter colored stream some with more red. Out of 800cc I produced 600cc in five tries, total accumulated.
I was very impressed with the stream strength, incremental increase of volume. The notable sting was tolerable, enough to make a grimace, but I bared down like I was trying to defecate and pushed my stomach out to start the stream. I also discovered that I was able to stop the stream. I also achieved three full erections, unintended!

4:25 p.m.
Discharged. I was still a little hazy from the anesthetic, but I walked comfortably and with only boxer briefs and a #1 Men's brand liner shield I was alert enough to take the subway home.
Nocturia
Went to sleep after taking Aumentin 500/125 mg + Ibuprofen. Two hours before the antibiotic I took refrigerated probiotics and ate two flavored yogurts and a croissant to stave off any upset. I woke up to urinate three times.

May 4
7 a.m. Alarm for Augmentin + Ibuprofen taken after yogurt and mini croissant. Returned to sleep.
12 noon

Awakened, took psyllium powder and probiotics.
Urge to pee is frequent as I must keep up the fluids with this damned antibiotic and ibuprofen (both toxic to kidneys) especially after the damage from hydronephrosis putting me at stage 2 CKD with an eGFR at 71 currently, it has remained between in the 70's for more than 3 months with normal creatinine. Pre-op eGFR was at 71 creatinine 100, or 1.0.

I will continue with observations eg. IO's of fluid, urine color, REST, some walking at dusk and eating legumes, garbanzo bean salads with white chicken, arugula, oilve oil, water & herbal teas, probiotics and anecdotal nuances.

I am relieved and pleased, so far, and have more optimism than expected, but I have to keep it real within reason. Slow & easy wins the race and self compassion and care are tantamount.

May 4, 2024 Supplemental:

I have no pain. No stinging sensation present and no trouble to start a stream. I only push out my stomach to increase the force, I believe it's my way of compensating, it may not me necessary. Color is normal light yellow.
I have the ability to hold it in and the sensation of being "full" is slowly returning, but I anticipate it will take longer for the nerves to register after two years with a catheter and the residual general anesthetic + paralytic. Half-lives vary, and at my metabolic rate of rest, this is expected until I move around more around the next week.

May 2nd - 12 weeks post op.
From what I have read, most of my healing should be completed by now.

Where am I in the process?

Sex and Retrograde:
Ejaculation intensity is about 98% of pre-op. I'm only leaving off 2% because I still feel like there's something missing.
I'm making a big assumption that there is some nerve endings towards the end of your penis which gives you that completion or satisfaction feeling after ejaculation.
Since I do not feel the semen coming out, I miss that feeling.
It's not a visual thing it's purely sensual.
At times I could swear it's coming out the correct way, but it's not. I've actually had my wife check herself a couple times, nothing there.
My semen appears to be contained within the urethra or prostate. I’m assuming this due the globs of semen I urinate out after sex.
I've never had cloudy urine.

Flow:
If I'm full, within 5 seconds, I relax and it just comes out in a full stream.
If I'm not full, 15-20 seconds, I relax, feeling the urine coming down, slowly, but when it comes out it sprays until a full stream is achieved.
Pushing to start a stream is very common for me unless I'm very full.
Spaying is new to me; I did not spray prior to my surgery. It seems to have gotten a little bit better since I 1st mentioned spraying,

I have found that certain foods (salty) or supplements will cause a delay in starting a flow (15-20 sec), regardless of how full I am.

Burning:
I still feel, couple times a day, some burning at the end of my penis.
Nothing intense, but notable.

Some odds and ends:
Recently, in the perineum area, I feel like I pulled a muscle. Not sure how, not exactly sure when.
That lasted for a couple of days. And it literally felt like a pulled muscle on the right side of my perineum south of my rectum.

Stun gun shocks:
I used to get these on the right side of my perineum all the time. 3 weeks ago they shifted to my left side. However I have not felt any for the last week or so.
It literally feels like somebody briefly turned on a stun gun. The shock radiates from my rectum to the end of my penis. Very much a surprise when it happens.

Nocturia:
This one will not leave me alone. I get up on average between 2 and 4 times a night.
I still have bouts of anxiety when I'm trying to sleep, so on occasion I'll take Xanax, if my supplement stack doesn't work.
The Xanax allows me to sleep through the night without bathroom breaks.
The stack lets me sleep between two and four hours on average between bathroom breaks.
If I don't take the stack or xanax, sometimes, I can get two to three times between bathroom breaks.
Everything is dependent up on my anxiety level at bedtime.

May 2nd - 12 weeks post op

Habits:
Going to the bathroom, pre-op, multiple times before I leave the house is still a standard procedure for me, when it shouldn't be.

Regrets:
I have no regrets

The frog in boiling water metaphor is the best way I can describe my pre-op condition.
My condition declined over the years until I was about to reach the boiling point, but didn't recognize it. I automatically adapted to my new normal.

A few weeks post-op, I started looking back and recognized the extreme severity of my condition, mentally and physically.
Physically, it was bad, no substantial complaints on my current status.
Mentally, it was worse. This is something which will take me awhile to overcome. Occasional depression, anxiety is the main issue.

Depression is simply chemical, changes in body chemistry, since I no longer am on edge all the time, my body chemistry goes in the opposite direction some times.
Anxiety, I'm down to 3 times a week, mainly when I'm trying to sleep.

Pre-op days I would basically play beat the clock.
Could I get to sleep before I had to go to the bathroom? This was critical at the time because it took me anywhere from 20min - 2hrs to empty my bladder.
By that time I was wide awake again.
This is the source of anxiety which is lingering today.

I had holep in november 2023. Passed very little blood in the first 2 months and then saw spiradic tiny clots every few weeks. Its now been 6 months and still see occasional clots. Is this normal . Could it be late scabbing?

I had BPHlaser vaporization surgery 5 months ago,developed urethral stricture within a month, hat optilume procedure for stricture, done 3 months ago.
Every so often I pass brown small ?scab and other times red about 2 inch long thread like clot.at ti.es few drops of fresh blood oozing out.
Still has frequency. No UTI cancer stones.
I am not happy with all these post surgery issues.
Any wisdom?
Thanks