Has anyone experienced incontinence after HOLEP surgery ?

I am 4 months post HOLEP and my incontinence still persists. It is really bad in the morning when I start moving around after waking up. I walk 3 miles then do my pelvic floor exercises. I then take a shower change my diaper and am mostly good for the rest of the day with that 1 diaper. If I could figure out what is causing all the morning leaks I would be about 90% normal. When sleeping I wake up 2 times to empty my bladder and it works perfectly. Maybe a tablespoon of urine in my diaper. I will continue to walk and do my pelvic floor exercises and hopefully overcome the morning leakage so my wife and I can do some traveling.

I'm 67 and in good health, with a healthy BMI. I had a HoLEP in late January. I did not have any stress incontinence at all afterwards. However, at about a month, I wet the bed one night. It wasn't a deluge, but it was very upsetting. I did it again a few nights later.

I started wearing a male guard at night and that has been strange and kind of counterproductive because they work so well, I can't tell if I've urinated in them. So I started weighing them to see the difference between fresh and after wearing. I'm only leaking about 4-8 grams of weight when I do, which is pretty frequently (according to these weighings). I'm wondering if some of the weight is sweat. And even 8 grams is a pretty small volume.

My post-surgery instructions included pelvic floor exercises, which I didn't do until the first night I wet the bed. Now I do them religiously. After reporting the nighttime incontinence, the surgeon referred me to PT. They started me on pelvic floor relaxation exercises, which immediately caused significant leakage. I didn't quit, though. I do them in the shower or over a pad or one of those plastic urinals. (That symptom has reduced a lot in a couple of weeks. I can do them without leaking now.)

But I continue to leak in my sleep. And during the day, after I urinate, I feel that I can't get out that last bit of urine from my urethra/penis. If I sit on the toilet and do a pelvic floor relax followed by a contraction, I can keep getting a little bit more out each time. The PT suggested double voiding, which seems to help some. Now the surgeon recommended "milking the urethra." I'll see if that helps that.

I mentioned all this to my surgeon, hoping for some help. She was extremely dismissive of my concerns. She said that since I'm not having stress incontinence, pelvic floor exercises are of no use to me. She kept saying that the nighttime leakage is "multi-factorial" and could be caused my many things. She even said that the nighttime incontinence is not related to the surgery! (I should point out that I've never had it before and it didn't start until after the surgery.)

I'm wondering if any of you have had similar experiences.

Oh, and the new experience of being able to urinate and empty the bladder is extremely pleasurable. I had forgotten how good it feels. Except for this incontinence, I am extremely happy with the outcome. Of course, I'm expecting the nighttime leakage will stop at some point.

As an aside, if you're worried about pain from the procedure, I would say that because one's tolerance of pain is subjective and varies from person to person, you can't be sure what you'll experience. In my case, post procedure pain was minor. Initially, the area around the tip of my penis, where the catheter moved around and abraded, was the most painful (but not very much). I was scared about taking out the catheter, but it was smooth and easy. The first few days, I did have pain with urination. Some of it was a burning and some of it was like pushing little grains out. Also not bad and it was completely gone after a couple of weeks. In my case, I did not use any of the prescribed pain meds and only a couple of Ibuprofens during the entire recovery period. To me, the worst of it was no worse than pushing out a dried plug of semen. I don't consider myself as having a high pain tolerance, so I guess I just got lucky.

I had holep Jan 21st. 2025. No pain what so ever. Couple days of bleeding and incontinence. Then everything cleared up for a month. Like you after a month I started leaking at night. Mine is night time only. Not nightly but never know when so I am wearing the pull up diapers just in case. The 24th I have my next appointment with the doctor. I'm doing the kegels 3 times a day but have not seen a PT.

My HOLEP was at end of 2024 and still have incontinence like yourself. I also do daily kegels. My imcontinence is slowly getting better. Everyone heals differently and not at the same time. Keep the faith. Things will get better but on your body's timetable.

It appears we both are using the Mayo Clinic in Phoenix/Scottsdale. What was your 3 month check up like? I have two appointments in one day. What tests did you have or what are they looking for?