Is HoLep recovery worth the procedure?

@cotidiana
I am 71 and fortunately have not yet had these issues that you and others have been dealing with.
That being said, we all have to decide our quality of life and how to deal with health issues. The ER episodes definitely causes you to take a close look at resolving the issues. We have to find doctors we trust and hospitals we are confident about. Trust your gut feelings and again....focus on your quality of life right now and take the steps you believe will bring improvement. You got this! I hope all goes well for you!
Dave

Yes yes yes on the Holep. I had Dr Cheney at Mayo Clinic Phoenix May 2025. No pain or bleeding. Incontinence lasted 7 months, but got less and less each month. Finally got fully resolved. Worked with pelvic floor PT. Finally I started doing leg weights and resistance machines while doing my keegles . That got me over the hump. It does seem to be the skill of the surgeon that matters. Dr. Cheney has performed over 3000. Good luck

I had HoLEP surgery in 2021 or so. Procedure went well and I have had no problems since. No real side effects except for retrograde ejaculation, which I was told about. In my opinion the main difference between a good outcome and a bad one is the skill of the surgeon. Mine had done literally thousands of them and did a fellowship related to doing them so had the best possible training and experience. That is what you want.

Hi, I find it really interesting to read about all of the varying outcomes post HoLep. I had my procedure done in May of 2025. It was performed by Dr. Cheney at the Mayo Clinic Phoenix campus. I am 74 yrs of age. I had a catheter inserted for 24 hrs and then removed. My results have been really good. Two days of bleeding and no pain. Incontinence was my issue. I worked with a pelvic floor PT for months. In fact, I started a month prior to the surgery with keegel exercises. Each month the incontinence got better. By seven months it had completely resolved. One thing that really helped that I might suggest…I started doing my keegels at the same time as I worked out at the gym. I used weights with lower leg lifts, as well as doing the same on resistance machines. The key was doing the keegels at the same time as doing the exercises. Within two weeks of trying this the incontinence was completely gone. It has been two months now with no pads. HoLep for me was a game changer. It gave me back my life. Hang in there and keep doing the keegels. Definitely go to a pelvic floor PT. Good luck to everyone.

@oldfiddler
I am 12 months post holep. 67, good health, prostate was about 87. No incontinence problems prior to surgery. I continue to have a disaster of a holep recovery. The dr. at Penn State health Hershey, pa. who did the surgery was uninterested in my problems and referred me to another surgeon for artificial sphincter surgery at the six month follow up. I leaked profusely for the first six months. Quality of life is awful. What I have learned since, this holep procedure is very stressful to your sphincter. The instruments are somewhat large, stretching your sphincter and it takes a long time for a surgeon to get good at it. They go in and out of your sphincter alot during the surgery. So who do they practice on until they get good at it? You. I still do kegels, I went to PT and so on. Tried some acupuncture also. As far as I can see this doctor failed me. I have another test coming up next month but from what I have been told this sphincter thing is a done deal if I want to stop leaking. So good luck and be aware there is no going back. The information I found on the internet does not agree with what they told me prior to surgery. There is a lot of incontinence problems with Holep, some minor some not.

@rwinpa this parallels the experience I had. My surgeon was relatively young and I was so anxious to plunge ahead I never challenged him on his experience. I believe I was also a “practice with no mentoring surgeon” patient whose urethra was wrecked by excessive rectoscope time and manipulation. Similarly surgeon considered a smaller prostate a successful outcome and now just wants to hand me off for AUS. I’m now reluctant to jump into that and certainly won’t let the UW practice touch me again.

@hhibird your experience makes me want to ask lots of questions of a prospective surgeon. I really don’t know what questions to ask except for how many have they done and what is the number of successful outcomes?
Since I’m new to this would you tell me what is AUS and UW? I don’t get proper answers when searching online.
Right now I am considering PAE, Aquablation, or HoLEP. In that order. I had to get my primary care physician to send in a referral to UCSF Interventional Radiology so I could get a consultation with their physician.
UCSF doesn’t do Aquablation so I have an appointment in three weeks to find out more about that.
The doctor who does HoLEP hasn’t contacted me yet.

I tell you guys, I am scared. I am trying my best to decide with as much education as I can get. I’d like to get things moving before I need a catheter.

@oldfiddler I think I found out
AUS artificial sphincter
UW university of Washington
I just kept asking until the bot gave me an answer that sounded close to what I think it would be.

@oldfiddler yup. AUS is artificial sphincter with its own set of recovery periods and issues. Can’t stress enough challenging surgeons experience. I know of people who had no long term issues. I took the first available surgeon once I decided to go ahead thinking I’d be more likely to recover before planned Hawaiian vacation etc. if I’d waited 4 months for a more experienced surgeon I’d probably have been recovered months ago. Beware of how the medical practice uses patients to train new surgeons.

In my opinion incontinence after HoLep is downplayed by the surgeons. They just answer with hey, it is no big deal. I a had a youngish surgeon who was hot to perform HoLep on me. He would not answer when I asked how many he had performed. I waited a few months until the qualified surgeon at the Mayo Clinic could get to me. I had a good outcome in the end.
I do agree that the skill of the surgeon seems to be key. If you get an uneasy feeling after a doctors appt. then run. Do your research on them