Huge prostate (250) with urinary stop/start issues

Is your 250, 250 grams? Via MRI my prostate was just over 100 grams. My surgeon said 100 was the breakpoint between HOLEP and Robot Simple Prostatectomy. I chose Robot Simple at age 68 hoping I am one and done.

Sounds like you made a wise decision.
My urologist told me I was approaching a point of no return due to prostate size.
He recommended aquablation, and I went along with it.
After 4 months, I'm not sure that was the best choice for me.
So far aquablation has not led to measurable improvements, and some times wonder if I would have fared better with prostatectomy.

Is your 250, 250 grams? Via MRI my prostate was just over 100 grams. My surgeon said 100 was the breakpoint between HOLEP and Robot Simple Prostatectomy. I chose Robot Simple at age 68 hoping I am one and done.

Sounds like you made a wise decision.
My urologist told me I was approaching a point of no return due to prostate size.
He recommended aquablation, and I went along with it.
After 4 months, I'm not sure that was the best choice for me.
So far aquablation has not led to measurable improvements, and some times wonder if I would have fared better with prostatectomy.

I'm 61. My prostate was, and this is where I get confused: 110 cm, but the surgeon says 52 grams. Huh?
Well, in August 2022, I had been having some strange symptoms, I wasn't sure if it was heart related, if I had covid, an embolism, I didn't know. I felt dizzy, panicky, I knew my blood pressure was high, especially diastolic, and I got winded easily and had flank pain which I thought may have been a stone. Blood tests were normal.
Then I got an ultrasound of my abdomen. They told me that I not only had urine in my bladder, but that both of my kidneys were over-sized, full of urine that had backed up for god knows how long. They told me to go directly to ER. I had another ultrasound and they also saw that my prostate was enlarged and interfering with elimination.
The rammed a catheter in my urethra. It was the most traumatic experience I have ever had, outside of totaling my car 30 years ago. After a four month wait, I finally saw a urologist who told me that I would need surgery. I asked for HoLEP. Another two months go by and I get to see a surgeon- who turned out to be a specialist in TURP. I asked where the other surgeon was who specialized in HoLEP, no answer. I took the opportunity to demand an MRI because I didn't want a needle biopsy. He set up an appointment.
I was in CKD stage 3a, which concerned me a little because of the gadolinium contrast dye they use. It never leaves your body, ever. They used ProHance on me. This dye is indicated for renal insufficiency. However, the FDA recently issued a warning on all gad dyes. My reasoning was that if they needed to do a needle biopsy, they know where to take it if it shows up on MRI.

The MRI results were PIRADS 2, "least likely" for prostate cancer, none detected.

Another four months and I finally get to see the surgeon who does HoLEP. It turned out that he was the only experienced HoLEP surgeon, but then at the last minute he remarked that he may not end up being my surgeon. No warm fuzzies. I recorded the entire conversation, had notes and took notes - HIGHLY RECOMMENDED.

After a YEAR, still wearing a Foley catheter that they have to change every two months, with chronic bladder infections, antibiotics and feeling run down all the time for lack of sleep, I get to have surgery! Only, they tell me that I will not get to meet my surgeon. This is in Barcelona, Spain, mind you. No warm fuzzies. I must also mention that I am completely alone, unmarried with no close family or friends.

After the surgery, I was told that it only took one hour. The propofol experience was seamless. I never knew that I was going out. They used propofol and rocurium (paralytic). I was in the hospital overnight with constant irrigation which was not painful, I didn't notice it. Toward the evening of the day of surgery, the bag was almost running clear, very light cranberry juice color. By morning, it was almost clear. The TURP surgeon came in with some residents. He said it was remarkable how quickly the curation was going. He informed me that the surgeon was the head of all of the surgeons. I was informed that they would be taking out the catheter that afternoon. They wanted to see if I could pee on my own. I drank a lot of water. It took about two hours for it to evolve from a drip to a drizzle to a full stream. I actually had a full erection while trying to urinate. I didn't expect this at all, but it was encouraging.

This surgery was on May 2, 2024. It is now September, 2024. I pee like when I was a kid. I do have pre-semen, I can get an erection, but the ejaculation is retrograde, so it's basically pee that squirts out (if I have anything in the bladder) instead of semen. I have had an occasional light dull ache in the perineum (taint) area, and occasional urethra sting at the tip of my penis. Other than that, thae only thing that has impeded my progress, was the year and eight months wait. The delay caused limited movement due to the Foley discomfort, lingering side effects of antibiotics to this day, made me pre-diabetic with poor gut motility resulting in electrolyte imbalances, low thyroid and some bone fusions lower lumbar. Maintaining my health during this wait was a FULL. TIME. JOB. The pathology came back and they did find less than 1mm of malignant tumor at Grade 2 Gleason 3x4. This may seem like nothing, but those "in the know" know it's not about the size, it's about if any of it got into the bloodstream. It's a highly vascular area, the prostate, so I am on active vigilance to check my PSA. I hope it is close to the zero ranges. This will happen in October, because it takes time to heal and they want to avoid a false positive elevated PSA; time for all the inflammation to resolve itself.

My research shows that HoLEP is not prostate size specific, in fact I have read that it is recommended.
I recommend demanding an MRI before biopsy is mentioned.
I recommend HoLEP. It's a one and done and no regrowth with the necessity to return for another surgery.
I hope that you get what you need and have a swift recovery. I have also written more detailed information under: After HoLEP . . .

Thanks for your excellent review of your ordeal. It's very helpful. 2 lessons from all this are YOU need to be in charge of your own medical care and it's vital to choose the Right doctor!

I'm 61. My prostate was, and this is where I get confused: 110 cm, but the surgeon says 52 grams. Huh?
Well, in August 2022, I had been having some strange symptoms, I wasn't sure if it was heart related, if I had covid, an embolism, I didn't know. I felt dizzy, panicky, I knew my blood pressure was high, especially diastolic, and I got winded easily and had flank pain which I thought may have been a stone. Blood tests were normal.
Then I got an ultrasound of my abdomen. They told me that I not only had urine in my bladder, but that both of my kidneys were over-sized, full of urine that had backed up for god knows how long. They told me to go directly to ER. I had another ultrasound and they also saw that my prostate was enlarged and interfering with elimination.
The rammed a catheter in my urethra. It was the most traumatic experience I have ever had, outside of totaling my car 30 years ago. After a four month wait, I finally saw a urologist who told me that I would need surgery. I asked for HoLEP. Another two months go by and I get to see a surgeon- who turned out to be a specialist in TURP. I asked where the other surgeon was who specialized in HoLEP, no answer. I took the opportunity to demand an MRI because I didn't want a needle biopsy. He set up an appointment.
I was in CKD stage 3a, which concerned me a little because of the gadolinium contrast dye they use. It never leaves your body, ever. They used ProHance on me. This dye is indicated for renal insufficiency. However, the FDA recently issued a warning on all gad dyes. My reasoning was that if they needed to do a needle biopsy, they know where to take it if it shows up on MRI.

The MRI results were PIRADS 2, "least likely" for prostate cancer, none detected.

Another four months and I finally get to see the surgeon who does HoLEP. It turned out that he was the only experienced HoLEP surgeon, but then at the last minute he remarked that he may not end up being my surgeon. No warm fuzzies. I recorded the entire conversation, had notes and took notes - HIGHLY RECOMMENDED.

After a YEAR, still wearing a Foley catheter that they have to change every two months, with chronic bladder infections, antibiotics and feeling run down all the time for lack of sleep, I get to have surgery! Only, they tell me that I will not get to meet my surgeon. This is in Barcelona, Spain, mind you. No warm fuzzies. I must also mention that I am completely alone, unmarried with no close family or friends.

After the surgery, I was told that it only took one hour. The propofol experience was seamless. I never knew that I was going out. They used propofol and rocurium (paralytic). I was in the hospital overnight with constant irrigation which was not painful, I didn't notice it. Toward the evening of the day of surgery, the bag was almost running clear, very light cranberry juice color. By morning, it was almost clear. The TURP surgeon came in with some residents. He said it was remarkable how quickly the curation was going. He informed me that the surgeon was the head of all of the surgeons. I was informed that they would be taking out the catheter that afternoon. They wanted to see if I could pee on my own. I drank a lot of water. It took about two hours for it to evolve from a drip to a drizzle to a full stream. I actually had a full erection while trying to urinate. I didn't expect this at all, but it was encouraging.

This surgery was on May 2, 2024. It is now September, 2024. I pee like when I was a kid. I do have pre-semen, I can get an erection, but the ejaculation is retrograde, so it's basically pee that squirts out (if I have anything in the bladder) instead of semen. I have had an occasional light dull ache in the perineum (taint) area, and occasional urethra sting at the tip of my penis. Other than that, thae only thing that has impeded my progress, was the year and eight months wait. The delay caused limited movement due to the Foley discomfort, lingering side effects of antibiotics to this day, made me pre-diabetic with poor gut motility resulting in electrolyte imbalances, low thyroid and some bone fusions lower lumbar. Maintaining my health during this wait was a FULL. TIME. JOB. The pathology came back and they did find less than 1mm of malignant tumor at Grade 2 Gleason 3x4. This may seem like nothing, but those "in the know" know it's not about the size, it's about if any of it got into the bloodstream. It's a highly vascular area, the prostate, so I am on active vigilance to check my PSA. I hope it is close to the zero ranges. This will happen in October, because it takes time to heal and they want to avoid a false positive elevated PSA; time for all the inflammation to resolve itself.

My research shows that HoLEP is not prostate size specific, in fact I have read that it is recommended.
I recommend demanding an MRI before biopsy is mentioned.
I recommend HoLEP. It's a one and done and no regrowth with the necessity to return for another surgery.
I hope that you get what you need and have a swift recovery. I have also written more detailed information under: After HoLEP . . .

Regarding an MRI prior to a biopsy.
I had that MRI, with the results showing no indication of cancer. My urologist still insisted on a biopsy, saying that while the MRI is helpful, it is not definitive on ruling out cancer.
I resisted the biopsy because my PSA number only rose (to about 7) after I stopped Finasteride. It made no sense to me that stopping Finasteride could cause cancer to suddenly develop.
In any case, I did settle on Aquablation. Post surgery pathology showed no sign of cancer.
Meantime, I continue my too gradual recovery from aquablation.
Still need Depends, and I still wake up at least 2 times most nights.
An improvement since the surgery, but not y et back to where I was before the surgery.