My Background & Upcoming HoLEP — Would Love Your Insights

78 had HOLEP at 74, best thing I ever did for my health. Prior to surgery had chronic prostatitis, severe back pain once or twice every couple of years, bladder holding way to much urine, up 2 to 3 times per night, prostate 200mm, took flomax and others for over 20+ years, had to self catheter last 3 months, had retro for years do to flomax, always looking for a bathroom. Surgery took 2.5 hours and I stayed in the hospital 1 night. Able to urinate the next morning, catheter came out and home I went. Was in pads for maybe 2 weeks with some bleeding and a little urine. After surgery probably urinated best in my life and still fine today. Started to sleep through the night and do so today ( how much better I feel with a good nights sleep). No more Prostatitis and PSA seems to have settled in at 2.5. During the day, not focused on the next bathroom. I drink one large cup of coffee per day and probably started back in less than a week. Did not workout or play golf for 30 days. As I said above the Retro for me was there before I decided to have the HOLEP. I have lived with the Retro and not the end of the world.
Hope this is helpful and you get the success I have experienced.

Skip

@skipz Greeting for another central Illinois resident. Had my HOLEP a couple of years ago, extremely pleased with result. I had it done at Indiana Univ Medical Center/ Indianapolis. They kept me there over night and left the next afteroon. About 2 weeks to non pain/urination. Had to have catheter for about 12 months, until finally Holep. I do miss orgasm, and have to accept the Retro, but it's the price we all pay.

Hi wavelight2020. I had BiPolEP in Jan 2022, very similar surgery to HoLEP, just a slightly different heated cutting tool. I was just shy of 70 yrs old at the time, prostate of 120cc with a large median lode blocking the bladder outlet. I had suffered the usual BPH symptoms for at least 10 years until I could not empty my bladder. I had PVR tests showing I had 600+ ml of urine in my bladder post void which resulted in being on a catheter for about 40 days leading up to surgery. I live in the Pacific NW and flew to Minnesota to have the surgery at Mayo Clinic - Rochester. I had surgery early morning of day 1, spent 1 night in the hospital on a catheter, had cath removed the next morning and pee'd Great shortly after, and was then released from hospital. I felt like I was completely emptying my bladder from that very first pee after surgery. I spent 2 nights in a local hotel, then flew home which was 3 days after surgery. My Doc said I could fly on the second day, but I stayed the extra night because I felt tired and I was traveling alone. The procedure itself was relatively painless, just a mild, dull ache in that area the first 48 hours which was handled by acetaminophen. I did not really have any incontinence, just some bloody ooze which was handled easily by a thin shield in jockey shorts. I don't remember that lasting more than a week to 10 days at the most. Peeing was a bit painful for the first 5 to 10 seconds of flow for about a week, then subsided. I was back to short, casual walks around the neighborhood in about a week. Having a fairly large median lobe did not seem to effect my outcome at all. I don't recall being told to avoid caffeine but I mostly drink decaf coffee, so that was not an issue for me. Permanent retro-ejaculation is nearly guaranteed. I admit that I missed it at first, but now 4 years later I am used to it and it is no big deal. I understand being nervous, it is surgery after all. But honestly... I wish I had done it much sooner rather than waiting until things shut down and I couldn't empty. You have your younger age and good health in your favor. If you have any further questions feel free to post them here or you can message me directly. Best of luck to you!

I am aged 75 now, but one yr ago I had Holep done at Mayo Clinic in Phoenix. I had a 134 gram prostate with a medium lobe. The surgery was easy compared to my expectations. The surgery changed my life for the good. Peeing normally is a godsend. My issue was incontinence post surgery. It got better monthly, but lasted 7 months. A pelvic floor pt for me was indespensible.
Sex is still good, and you get used to RE. I do not for one minute regret my decision to go with Holep. It is scary to contemplate the surgery, but do not let that stop you. From what I read in here, picking the surgeon is critical.

Thanks so much to all of you for sharing your experiences. I've gone back and reread each reply a couple times now, and they've all been really helpful.

Skip, the fact that you're sleeping through the night and not always scoping out the nearest bathroom. Good to hear coffee came back fast too.

cent66, nice to see another central Illinois person on here. Glad things turned out well for you even after a longer road getting there.

oldman, your story is probably the most directly relatable to mine since you also had the big median lobe and high PVRs. Hearing that you felt like you were emptying completely right from that first void is pretty amazing. I might take you up on the offer to message you directly as I get closer.

wally920, I really appreciate you being upfront about the seven months of incontinence. That's my biggest fear. I've been trying to do Kegel's so we'll see...

I'm still nervous, not going to lie. But hearing from all of you has helped a lot. Sounds like the surgery is worth it, recovery takes some patience, and the surgeon choice is crucial. Feeling good about where I landed on that front.

I'll post updates along the way... hopefully I hav a positive experience and can help somebody else the way yours have helped me. Thanks again everyone.

@wavelight202
Good luck!

I would like to offer you reassurance for your upcoming HoLEP surgery. You did the research, chose a procedure that is best for you and have a phenomenal surgeon (watch some of her YouTube videos - she’s incredible). I had HoLEP 2 July 2025 by Dr Austen Slade in Boise, another world renowned HoLEP surgeon. I’m 71 and was in full retention so had a catheter placed in the ER prior to my visit with him. My prostate was smallish also 50-60cc, had been on Flomax for a decade. My results have been outstanding. No cancer detected via biopsy of the prostate “chips”, I urinate well, never had incontinence from day one, can sleep routinely 6-7hrs without getting up, a 0.2 PSA and my last residual volume test by the Urologist was zero. RE is a given, I knew that ahead of time. I take comfort that the need for future BPH surgery when I’m much older is very very low. The procedure is low pain, I only took a few Motrin. There is intense burning at the beginning of urination for a few days but that passes. Very little to no bleeding, no clots. At around a week I passed a few dark colored scabs. I did have very strong bladder spasms for around a month, doing Kegels helped with that. Ask if Dr Krambeck’s protocol includes Botox injection of the bladder. If that is available I would opt to do that, it is supposed to help with the intense spasms. Do not let yourself get constipated, you do not want to push. Take whatever works for you to help with that. I love coffee, stayed off it for two or so days and reduced my intake. It will really irritate your bladder, even now 1 year later but I just deal with it. Best wishes, you’ll do fine. Keep us posted with your progress.

Remember that many people with successful HoLEP results don’t use forums. They just move on and don’t look back. People with problems come back for help or to complain. Factor that into your research. I had successful HoLEP surgery just over 1 1/2 years ago at Mayo in Jacksonville with Dr Dora and his team. 69 year old, very active, in shape, sports oriented male. Prior to surgery had BPH being somewhat managed via medication but not great. Not emptying bladder, constant urge to go, interrupting daily activities and trips to constantly find a restroom, wound up with 2 ER trips for Acute Urinary Retention. It was negatively impacting my life. Surgical experience was a breeze (Mayo Jax is impressive). Afternoon surgery, spent the night at complimentary onsite medical hotel and left the next morning/afternoon for the followup visit and to have the catheter removed. I had my wife with me which was an incredible help (I recommend having someone accompany you for surgery and that night after). The next few days were a bit rough. We stayed in Jacksonville for a few days post op just in case. Bloody discharge and a bit painful but expected. General overall discomfort. Wore full Depends diaper for a few days then graduated to a thick pad and after that to a thin shield. Don’t overdo it in terms of getting back to your daily routine. Don’t be a couch potato but slow and steady wins the race. I don’t honestly remember what I did in reference to coffee consumption but if I abstained it was only for a short time (I only have 1 cup in AM anyway). I progressed wonderfully and was feeling back to normal until a setback a month in. Frequent urge to urinate, pain at prostate etc. Doctor said sometimes happens and to stay the course. I did and it resolved itself fairly quickly. So a year and a half later and getting the HoLEP is one of the best decisions I ever made - I have my life back. Good luck with your surgery.