Is HoLep recovery worth the procedure?

I too had a HoLEP with a Dr. in Boise-Urologist Austen Slade one month ago. I am 74 years old and had BPH symptoms for about 25 years. Getting up at 4-5 times a night, urinating 20-25 a day. Had UroLift procedure 7 years ago which helped some for about 4 years. Most recently developed a large bladder stone and had nights of being up 13 times. My local doctor wanted to do a TURP. I researched and found out about HoLEP. Only a few doctors in my state could do this. Reached out to Dr. Slade, we had a Boise trip planned in two weeks to visit family there. He called me and arranged an office visit when we arrived on a Friday, performed the surgery the following Wednesday. Took the catheter out the next morning, had some minor irritation and bleeding for a week, took a week off from build Habitat homes and then back my same schedule. This procedure was way less painful than the UroLift, quicker recovery and much improved results. Now I often sleep through the night and no more frequency and urgency issues. I highly recommend this procedure, and the very professional team Dr. Slade has. For me they were an answer to my prayers!

@sittingdeer I believe it can be worth it with experienced surgeons. Unfortunately I rushed into it with an inexperienced surgeon and after 9 months are headed for permanent leakage. The practice is dismissive with little support other than referring for more iffy procedures like AUS. It is a miserable quality of life. Beware of the hype and check out your surgeon.

12 days post-op
I'm glad to see most of you are pleased with the holep results so far. After 12 days post-op my experience is nothing but negative. After being diagnosed with BPH about 15 years ago I had been managing it with medications with acceptable results. Getting up once per night was manageable. More recently though, ultrasounds showed I was not fully voiding my bladder and was retaining 200-300 ml on a regular basis. The urologist told me this could lead to serious problems in the future so I opted for holep. I spent one night in the hospital and the following day the catheter was removed and I was discharged home. Every day since my discharge I have had total incontinence. It is constant leakage with my bladder never filling up enough to even pee normally. The urine leaks out of my bladder as soon it enters from my kidneys. I have not seen any improvement in these first 12 days. Maybe it is just too soon to judge but I now question if I made the right decision to go forward with holep. I went from a very manageable situation to one which is now much worse. I'll just have to see what happens over the next few weeks but thus far it has been terrible and I am afraid to even leave my house. Quality of life has greatly deteriorated.

@oldfiddler I understand completely. My surgeon downplayed the side effects of holep and now I am finding it is much worse than I anticipated. In hindsight I would have trusted my body instead and not done it. I have no idea what the final outcome might be but right now my quality of life has greatly suffered.

@leo3
I had similar issues during the first two weeks I didn't even had to use the toilet. Im going on week 8th and it's much better. The incontinence is present but manageable, i usually change my pads two times a day and for the night I use the overnight Depends just to be on the safe side in case of overnight leakage. As for going out I wear a regular Depend and I can be out 3 t 4 hours safely.

@hellofreedom
I will start physical therapy tomorrow will post result.

@leo3 I had holep almost 3 months ago. Surgery was fine , left after few hours and removed the catheter the next day. Small blood drops in urine stopped about a week ago but leakage and dripping is very very annoying. I don’t even feel I’m dripping most of the time . Using about 3-4 diapers every 24 hours . Iron Flow is great and much better than before but leaking is terrible. Done at Kaiser and I believe surgeon removed A LOT including the muscles by the bladder. She said leaking could take up to one year. Some statics shows that 5% won’t even fully recover after one year .I hope this is not the case .

I am scheduled for a RORP in May. Am thinking if I have continued leakage I would try the ProAct system. Has anyone ever tried this or know anything about it? I know there is a mesh sling, utheral bulking also, but the ProAct seemed better??

@hellofreedom Thanks for your reply. It sounds a bit more encouraging. I am still in the constant leaking stage and have not seen any improvement. It's good to know you are doing better.

Highly acclaimed Dr. Kapil Sethi performed my Holep on 19 June 2026. This was subsequent to a Greenlight laser surgery back in 2012. This is is consequence of having BPH at a younger age - you end up having to undergo a 2nd procedure to address "regrown prostate", years later.
The most anxious part of this process is waiting for the anaethesia to "TKO" me!

** 60 hours post-HoLEP (Surgery on 19 June).
** Catheter removed after a 38-hour attachment).
** Urine is completely clear with no visible pink tinge or blood clots by 44th hour post Holep.
** Involuntary bladder release occurred between hours 48 and 60 but has now stopped.
** Bowel function is active (5 bowel movements) with no straining.

Why the need for a Holep 12 years after Greenlight in 2012 as a 57YO? Prostate has regrown, and physically/ mechanically interfereing with bladder neck, when I run, and triggering hematuria after each run. I still run 3 times a week at 71 as I have been as an 18YO in 1974. So I didn't want this to prevent my running routine.

The big difference bewteen Greenlight and Holep:

(1) Catheter out within 3 hours post Greenlight and discharged on same day;
(2) Catheter removed 36 hours post Holep
(3) Greenlight entails passing out dead prostate tissue, lasered off and left in bladder, over the next 4 weeks
(4) In Holep, all lasered tissue removed from bladder (and tested to see if cancerous) - so expect clean clear urine by 48 hours post Holep as long as well hydrated, until week 4 when scabs will peel off from internal surface of prostate capsule, as part of healing. The amount of such "debris" flushed out via urine would be minimal compared to Greenlight laser.

NOTE: There is another difference between Greenlight and Holep that is immaterial in my case. Greenlight will always result in retrograde ejaculation due to removal of the bladderneck muscle in the process, while Holep has a sub procedure, the "part Holep bladderneck sparing" procedure that spares the prostate tissue around the bladderneck, hence enabling antegrade ejaculation. But since I already had Greenlight 12 years ago, this was a mute issue in my Holep procedure. But note - sparing antegrade ejaculation, by sparing prostate tissue around the bladder neck, means the prostate will regrow from the prostate tissue left behind in the "sparing process".