Is HoLep recovery worth the procedure?

Posted by lovethealoha @lovethealoha, Feb 9, 2025

I had Holep with a Dr. in Boise-Urologist Austen Slade. Today makes 10 days post surgery. I’m 51 in general good health, no allergies or underlying issues. My BPH was at its max , complete blockage. Prostate and Median Lobe. I could not no. 1 and a catheter was being recommended indefinitely. A cystoscope exam with my surgeon showed I was one of few patients with this condition that can be treated with possibly preserving all / most sexual functions. That being said. Here is my experience ( so far)
My outcome doesn’t represent all outcomes as different patients have different experiences and health risks. Post procedure, my catheter was removed in less than 14 hours, with the ability to use the restroom after a supervised test run by 5 am the next morning.
Since I showed no signs of distress, coherent, no fever , or pain (slight discomfort ,yes) it started off really good. After several drs discussed my progress I was released.
Follow up calls were daily for a few days.
Day 2-4 surprisingly , urine remained clear. Also most bathroom trips , occasional light blood and a sting that subsides quickly especially with ibuprofen.
Today is day 5 , some blood today in the evening , dismal sting , but zero pain since after surgery. Completely mobile.
Day 10 only thing left is a numb feeling in the area treated. My bathroom health is 100 percent restored. If there’s any irrepressible symptoms or damage. It’s too soon to know.
It appears to function but I’m avoiding any excitement for 4 weeks.

As of now, Not straining or lifting anything heavy. Drinking loads of Water for first week to keep flushing. Resting is also important.
Wishing you all future patients a speedy recovery and may your pathology test be negative as well.

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Profile picture for gemstat @gemstateid

A Boise urologist was excited to try HOLEP on me, though I had previously a TUMT and laser PVP. Every urologist is gung-ho, it's great, minor symptoms, everything will be awesome. I asked the local doctor, "how many have you performed?" He replied, "oh, about 200 so far." I informed him that he was already 10 years behind the leading doctors in the states, and no, I declined to go ahead with a third surgery.

Net-net is that every person is different. I see NO way for a doctor to predict what your outcome will be. The first doctor in Florida neutered me almost, despite him showing me videos of happy men experiencing TUMT...when there were already better procedures available! Stupid me for not researching! It was scare tactics with urine retention that rushed me into the horrible and painful TUMT.

The conservative path is to stay on flomax and self-cath. You get used to it, it's fast and predictable. You will have side effects with surgery. It's just the magnitude. Per the maxim, you can hope for the best, but you better plan for the worst outcome. And that could have a serious impact on your life as it has mine.

Note: this is just one mans experience.

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@gemstateid I had HoLep procedure on one of the largest prostrate possible 212ml. 20-40 average. Surgery lasted 3 1/2 hours. You said you will have side effects with any surgery. I hate to disagree with you. I had zero side effects. It's now 1 1/2 years later. Absolutely zero effects. Best decision I made. I went to Mayo Clinic in Rochester, Mn. My Surgeon was Kevin Wymer, he was 35 years old when he did my surgery. He is one of the top surgeons in the country on very large prostrates. I would highly recommend him. I had no pain, no discomfort urinating immediately or any time after surgery. I felt like nothing was done to me. The only difference I notice is that now I pee like a teenager. As matter of fact the Dr. told me I empty my bladder now better than a teenager and I'm 69. Would tell anyone to have it done.

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Profile picture for not2bad570 @not2bad570

@gemstateid I had HoLep procedure on one of the largest prostrate possible 212ml. 20-40 average. Surgery lasted 3 1/2 hours. You said you will have side effects with any surgery. I hate to disagree with you. I had zero side effects. It's now 1 1/2 years later. Absolutely zero effects. Best decision I made. I went to Mayo Clinic in Rochester, Mn. My Surgeon was Kevin Wymer, he was 35 years old when he did my surgery. He is one of the top surgeons in the country on very large prostrates. I would highly recommend him. I had no pain, no discomfort urinating immediately or any time after surgery. I felt like nothing was done to me. The only difference I notice is that now I pee like a teenager. As matter of fact the Dr. told me I empty my bladder now better than a teenager and I'm 69. Would tell anyone to have it done.

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@not2bad570 I am familiar with your surgeon as he did one of my "scopes." He is an excellent urologist. The procedure I underwent was by Dr Kohler, another excellent urologist up there. I opted for the Rezum procedure since there was potential for fewer side effects. Indeed my side effects were nil, but my prostate apparently "gre back" after less than a year. Now I am considering the HOLEP procedure. The million dollar question of course is 'does the reproductive running gear still function satisfactorily.' After Rezum it was fine for me but after HOLEP, and your achieved desire of urinating like a race horse again, are you presented with RE or any other difficulties? Thanks for your time and best wishes to you and all suffering with these pesky issues...

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With holep you will have RE. Otherwise, no other real issues. Slight decrease in orgasm sensitivity. You miss the feeling of ejaculate coming out, however you do have an orgasm that is very close to your original. At least that's the way it is for me

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I tried the less invasive procedures like urolift and Aquablation with no lasting relief. However, I found out later a resident did the Aquablation and then 7 month later the real surgeon that was suppose to do surgery did a scope and said I need an Aquablation revision. So far I have not done anything. Just taking Flomax.

I do know someone who had HOLEP and they still have some leakage issues at times and it's been about 3 maybe 4 months. Had lots of leakage first month. From reading on here, that does seem to be an issue? However, I also think that most folks that have no long term issues aren't going to be posting. It's only when things don't go right that you want to let the world know.

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Profile picture for diverjer @diverjer

I tried the less invasive procedures like urolift and Aquablation with no lasting relief. However, I found out later a resident did the Aquablation and then 7 month later the real surgeon that was suppose to do surgery did a scope and said I need an Aquablation revision. So far I have not done anything. Just taking Flomax.

I do know someone who had HOLEP and they still have some leakage issues at times and it's been about 3 maybe 4 months. Had lots of leakage first month. From reading on here, that does seem to be an issue? However, I also think that most folks that have no long term issues aren't going to be posting. It's only when things don't go right that you want to let the world know.

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@diverjer I had holep six mons ago. I have a little bit of occasional leakage. All said, the results are very good. Dr Cheney at Mayo Phoenix performed the procedure.
I highly recommend it. I have RE, but it is no big deal. A small trade off to no longer have pee issues.

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Good to hear, happy things worked out for you, Yes, I know that RE is something that is expected. My friend only has leakage problems if he sneezes, cough or lifts something too heavy. He is a old country boy, so very active. I believe things are getting better for him. I don't bug him everyday, figure he will let me know on his own how things are going.

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I am 12 years post HOLEP. A little leakage. Some days none. Wear a thin pad. Recovery no big deal. Settled down quickly. Never get up at night. Drink water right up to bedtime.

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What do you consider a “little” leakage?

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I am on day 4 of the HOLEP, took the catheter out on day 2. I had a turn about 18 months ago but recently the Doctor said I was not emptying my bladder. I am not peeing as good as before last Thursday. The doctor said the procedure was successful. I haven’t had a strong stream, maybe 5 times since removing the catheter on Saturday. I don’t have pain or burning. I’m wondering if inflammation is keeping me from emptying my bladder. Should I be concerned or trust the process. I would think it should be stronger. He removed about 3/4 of tissue. I do have diverticulum that grew, a little pocket that holds some urine. Any thoughts?

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Profile picture for runningold @runningold

I am on day 4 of the HOLEP, took the catheter out on day 2. I had a turn about 18 months ago but recently the Doctor said I was not emptying my bladder. I am not peeing as good as before last Thursday. The doctor said the procedure was successful. I haven’t had a strong stream, maybe 5 times since removing the catheter on Saturday. I don’t have pain or burning. I’m wondering if inflammation is keeping me from emptying my bladder. Should I be concerned or trust the process. I would think it should be stronger. He removed about 3/4 of tissue. I do have diverticulum that grew, a little pocket that holds some urine. Any thoughts?

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@runningold
No doubt inflammation is present after your surgery. Give it time. But of course watch for acute retention where urine buildup becomes painful. Go in to er immediately if that happens.

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