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My Background & Upcoming HoLEP — Would Love Your Insights
Men's Health | Last Active: Aug 17 5:11pm | Replies (47)Comment receiving replies
I just had HoLEP surgery three days ago from Dr. Mitchell Humphries at Mayo Clinic in Phoenix. So far better than what I expected. My urine flow is effortless. A little bit of stress incontinence when I move around. But I know this will most likely go away once the inflammation goes down. I too was afraid of retrograde ejaculation. We shall see. I’m not sure if you’ve ever taken Flomax (tamsulosin). For me, it caused the worst retrograde ejaculation But it also relaxes the pelvic floor muscle muscles. So there was no contraction at the orgasm. The feeling stopped as soon as it started. I’m thinking and hoping this is going to feel more like a regular orgasm. Just nothing coming out forward. But I was retaining urine and creating bladder stones. I had some moderate damage to my bladder. If I didn’t do something about it, I probably would have no control of my bladder in the future. I know there’s other options but I am 59 years old and don’t feel like having surgery again or put back on medication in 10 to 15 years. Best long-term studies show the best results with HoLEP surgery.
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@alfonse congrats on your recent successful surgery. It sounds like we are in similar boats when it comes to age, need for intervention, recovery timeline and future “concerns“. I have taken Flomax in the past and discontinued it because I had the same experience you did. This is an interesting reply I received when querying Open Evidence:
“The Flomax Experience Was Likely Different From What Post-HoLEP Will Feel Like”
This distinction is important. Tamsulosin-induced ejaculatory dysfunction is now understood to be primarily anejaculation (failure of seminal emission) rather than true retrograde ejaculation — it acts on seminal vesicle/vas deferens contractility and possibly central 5HT1A/D2 receptors involved in the ejaculatory reflex itself.  This means tamsulosin may have been blunting the entire ejaculatory reflex arc, including the rhythmic contractions that contribute to orgasmic sensation. Post-surgical retrograde ejaculation is mechanistically different — the ejaculatory reflex and muscular contractions still occur, but the fluid goes backward through an incompetent bladder neck. The neuromuscular "pump" that generates orgasmic sensation remains intact.