HoLEP Log: What did you experience pre and post-op?

End of week (9 days as of today) post HoLEP procedure. May 2 (day of surgery) to May 11. Age 61, 105cc prostate, general anesthetic with propofol and rocuronium and gas inductions. I live alone and have taken care of all of my own needs. American in Barcelona, Spain.

Not as much incontinence as I expected. I can stop the stream at will and resume.
If I am full, some tiny dribble-squirts in my light underwear pad. Nothing dramatic enough to immediately swap out for a new one.
The first day post procedure while still in the hospital, I was left alone after catheter removal to pee.
I was taken aback that I was literally getting an erection. This ability has not stopped.

First week at home:
Bed rest.
Consuming high fiber foods, taking Augmentin 500/125 for 7 days. I finished as of Thursday May 9.
Urine started out as dark cranberry-color, but throughout the week later in the day appears normal in color.
At times there is a little stinging at the tip of my penis, but I found that pushing my lower abdomen out to force a stronger stream- I'm talking garden hose- settled the sting. The sting goes away completely by midday.

Nocturia
Note: I keep a large 8 liter water bottle near my bed to pee in while I am in bed so I can get back to sleep. I can also examine it upon morning for color. I see scabs and little clots at the bottom, the color is like a rosé wine, but this is due to dilution from nocturia multiple. Today's scab that was sloughed off was approximately 3 cm in length.

There has been urge frequency, but I prefer not to hold it in since I want to eliminate the antibiotic and any clots / scabs that may be there. If I am out, and experience the urge, I am able to hold it until the urge settles and I pee comfortable at home.

This week I did a test for erectile function. Too soon for this, but I felt compulsive and really need to be patient.
While stroking I discovered that a pre-semen fluid was coming out of my penis. I don't understand why, unless 1) the surgeon did a "partial enucleation," leaving enough gland behind, or, 2) it is traces of semen emerging through the urethra. My follow-up and cytology discussion with the surgeon is June 3.
Orgasm was achieved, yet it wasn't as fulfilling as when semen flows outward. The nerves in the urethra aren't registering the sensation of ejaculation and this could be that "thing" that is "missing." Instead of semen, it was a few shots of urine, not as comfortable since my urine PH is likely more acidic due to the antibiotic. Not the same. Neither would I care to ejaculate urine with a partner. I'm hoping this ceases at some point.

Presence of frank to light blood at the beginning of the day is present at the beginning of the stream, but quickly runs clear- normal in color. This could originate from the bladder and descend to the prostate capsule or an accumulation solely in the capsule.

I am resuming bed rest with occasional excursions to the market for supplies. No bearing of heavy weight, or extreme bodily movement. I have cabin fever, I am pale from lack of sunlight, but it will be a little time after taking Augmentin that I will be having any prolonged exposure to UV light.

I am very pleased with this outcome so far, the rate and pace of healing, all seem within textbook norm for the most positive outcomes and I would recommend this to any man facing surgery. I would have had the P.A.E. if it was offered here in Barcelona, Spain, under the socialized healthcare scheme; I had to demand HoLEP because I wanted to avoid blood transfusion risks. With a 105cc-sized prostate at age 61, under the extreme stress and elevated cortisol, I would eventually have it all removed for the factor of regrowth.

So far, so good.

Orgasms not organs

How long after HoLEP does the urine run clear? The frank blood has diminished, a tad of intermittent at the beginning, light rust color, short duration, but the urine is cloudy. I don't have a fever, no burning, or other symptom of infection other than cloudy. I drink at least three liters of water daily. My surgery was on the 2 of May. It is now about 23 days after surgery.

For me it was 7 weeks. I actually had a couple of spots about 9 weeks out as well. But it only happened once. You should be getting close. The only reason why I bled so long is that I am on blood thinners for my heart. So I tend to bleed easier and longer than most people. A friend of mine that had the same procedure said that he had no signs of bleeding around 5 weeks post op. Keep drinking the water. He also said around 4 weeks he had a bad burning sensation like he had a urinary tract infection, but it wasn't. It was just the normal healing process. As long as you're going to the bathroom you should be okay.

Your journal of recovering is incredibly useful - thanks for continuing it. I'm about a month behind you. At this point, I have some minor, fading issues with peeing. Mostly some dull pain toward the end of each time I relieve my bladder, and something related to what you've mentioned, in that if I pee when I'm not full up, it tends to be relatively uncomfortable. Also I've had to push at the end to fully clear everything out, which is unusual for me, and I am taking an extra 10-20 seconds to really make sure it's done. But my flow is 5 stars and I consider the surgery a success.

The two post-op issues I wish I'd known more about are sexual and exercise-based. I too feel like my orgasms are at 98%, and I also sometimes think I've ejaculated when I haven't. But there's something right at the end that's missing. I genuinely don't care if semen comes out (my wife is actually thrilled by this development) but it's like I'm missing the last chord in a blues riff or something. Also after orgasm my erection immediately vanishes, which is new for me.

The surveys I read before the operation are way too vague on the subject of sexual satisfaction - they seem to lump in "ejaculation" with "pleasure," rather than explaining what exactly men are dissatisfied about and why that goes away with time. Maybe we'll all get that last 2% back?

The other thing is exercise. I'm not massively athletic, but I do go to the gym four times as week and run three times a week. After surgery, my strength, endurance and focus plummetted. This might have to do with anesthesia, but it's been 2 months now and I'm just finally starting to be able to run more than a mile at a time. Slowly. My strength in the gym is still down 30-40%, and I can't really do many sets. I know that will come back, but it's a little depressing.

Thanks again for your notes.

That's interesting, why did they give you heparin? I was moving around quite a bit by 23 days. You will find the more you move around the more you will bleed. It's just a matter of breaking up the scar tissue and breaking loose scabs. So don't be surprised if you go beyond 5 weeks.