HoLEP recovery

@patrick78 After this last UTI, I messaged my urologist. I got an appointment next week on the 20th. Going to do a second cystoscopy . The first was nearly 1 year ago. He has another urologist that came out of retirement to help him and he is going to do the procedure so it will be a new set of eyes looking for what may be causing my UTI’s. In the meant time I go to my nephrologist tomorrow to check on my kidneys. I waited over 18 months to get an appointment. Living in Northwest Arizona limits the number of doctors available. I am on my 5th PCP in 6 years!

Thanks for the report @alexdav . I'm now seventeen days past my HoLEP procedure and have been reading this website and other user experiences to better understand my recovery. So I thought I'd sign up and report my progress.

One thing I've learned is that there is a wide variance in patient experiences. Some men seem to recover quickly with a strong urine stream, others take longer. Some men leak urine. Others don't. For me, my daytime flow has improved and I am emptying more of my bladder. I do not leak urine. But I still have an initial spurt of bright red blood when I urinate. I thought that would be gone by now. My urologist tells me not to worry, progress is often uneven. But I'm disappointed that I still have blood. I think I know why. I've long suffered from constipation and got accustomed to straining when sitting on the pot. I am taking a daily laxative but I still catch myself straining a bit and, when I do that, I get blood out the penis. So I just started using a combo approach—docusate + MiraLAX. I hope that will help.

My issue was difficulty urinating and sudden urgency, particularly at night. My prostate was 65cc when I had the HoLEP. I had been taking tamsulosin (Flomax) for about ten years when it stopped working so well. So the doctor doubled my dose but that didn't help much. Daytime wasn't a problem. But at night I was getting up six to eight times to urinate. That went on for a year. My sleep quality declined. My mood, alertness, overall health and quality of life declined. I discussed all the alternatives with the urologist: UroLift, Rezum, aquablation, HoLEP. I'm older and don't care that much about retrograde ejaculation, so I went with HoLEP.

Overall I'm satisfied although I feel that HoLEP is oversold a bit. Maybe I just didn't understand, but I thought I'd be back to normal in two weeks with a strong urine flow both day and night. But I still need to be careful about exercise, lifting, straining especially since I'm still getting blood. I spent one day doing nothing, just standing or lying down, to minimize any pressure around the perinium. The next morning, I had no blood when urinating. The following few days I walked and sat normally and also was pushing too hard when defecating, and blood came back. So I guess I'll need to be careful for some time. Otherwise, recovery will take even longer.

One thing I'm happy about, my nocturia has gotten better. I place two small cups on the bathroom counter. One cup has eight coffee beans in it, the other has none. When I get up at night to pee I move a bean from the first to the second to keep track of how often I'm getting up. I'm now averaging three to four bathroom trips. Last night was only two. That's a lot better than eight. I'm sleeping better at night, feel more rested during the day. Since that was my main complaint, I'd say the HoLEP is working as advertised. I wish my recovery was completely over and done with. I want to go back to strength training and home repairs. But I better not until the blood is gone and stays gone.

Had HOLEP 4 years ago. Prostate was quite large at 200. Many problems before HOLEP, but could not be happier after, quality of life greatly improved. Was on Flo-max for many years before HOLEP, so had retrograde before and after HOLEP. Best of luck.

@skipz
I understand there is retrograde ejaculation after HoLEP. But what about the intensity of an orgasm? Is it exactly the same feeling as an orgasm on Flomax? I’m scheduled for HoLEP. But the orgasms intensity while on Flomax are very diminished for me. I’m hoping it’s not exactly the same feeling after HoLEP. What was your experience?

My orgasm has remained the same even on Flomax. My retro started a year or so after taking Flomax, but no change in my intensity. Again no change from Flomax to Holep.

@skipz Thanks for replying. Flomax was horrible for me. Besides retrograde ejaculation, the sensation was horrible. It felt like a mini orgasm. But I was told it would be different after HoLEP. Now I’m concerned.

Here is my story- was 59 last July when I had the Holep procedure at Mayo Phoenix campus.

I had a relatively small prostate at 55cc. I had no idea about BPH until I got my first bladder infection. I could not resolve the continuous infections, so my cystoscopy
showed I wasn’t emptying my bladder completely. After discussing options, I thought I had decided on a Urolift because of minimal sexual issues. Doctor let me know the durability and long-term outcomes- might need another procedure again in 5 years. This is what made me decide on Holep- long-term solution with very little chance of having any surgery again.

I am in healthy condition with weight etc and never had any urinary issues until now.

Surgery went great. Afterwards, stayed overnight at hotel with Foley catheter. Went back next morning for removal. Then home. No pain, just rested.

I was very fortunate that I did not have any incontinence. Had diapers on hand and didn’t need them. I’ve read a lot of comments of men having incontinence, so I consider myself lucky.

Now, regarding sex- I first masturbated @ 3 weeks after Holep. Masturbation, intercourse etc all feels the same as before Holep. The orgasms, for me, are different.

My short time on Flomax did affect my orgasm quality. This is how my orgasms feel now, post Holep-

The feelings before orgasm are the same (great!) Then you experience the building pressure of an orgasm coming soon. I experience the same build up of tension in my groin and abdomen area on the way to a great release of pressure. At the moment of peak feelings, my orgasm feels like it stops right when it started. I get the same urgent feelings of wanting to explode in ejaculation, but since retrograde ejaculation, it all happens internally. I still get the same great relaxation feelings after orgasm and feel very relaxed afterwards.

My orgasms used to continue a few moments as you are ejaculating, more like a full body orgasm, but the orgasms seem muted- like the power gets cut off prematurely. I still very much enjoy sexual activity, and I still very much have a sexual appetite.

I believe that we all may go through periods of greater sexual arousal, then some days less so. I am very open with my wife. One thing that has changed- I used to masturbate privately, never letting my wife know (sometimes self-care feels good). But since Holep has changed my orgasms, I consider myself on a new sexual journey- I no longer hide. I take my time with myself to explore my body and find out what feels good. As men, we’re not supposed to be so open, but not for me any longer. I tell my wife now when I masturbate, how it went, how it felt etc. We still have a great sex life, but to continue my new journey of exploration, I masturbate to try new things or see what feels good-this is new to me since I was so private before. But being open to my wife helps me explain the differences happening in my body.

I have heard that for some men, prostate stimulation can achieve orgasm. I bought my first sex toy- a prostate massager. Found out really quick that I don’t have a prostate with any feelings.

A side benefit with retrograde ejaculation- no mess to clean up! After sexual activity, I go to the bathroom to pee. I usually take a minute- you can feel urine trying to come out, but sometimes the semen clogs the urethra and then whoosh- a big glob of semen in the toilet. And seeing the semen confirms that I achieved an orgasm.

Sorry for being so long- best advice is your extreme confidence in your surgeon. This is the only way to help ensure good outcomes. Even considering my orgasms have changed, I am still glad I had Holep for long term durability and no future issues.

Only you can make the right decision for you. I am taking this new chapter in my life as a new form of sexual awakening for me, to continue to find what feels good, have as many orgasms of any quality as possible and just be grateful knowing that life could be a lot worse! The best of luck to you and whatever decision you make. Feel free to reach out if any more questions.