Three-Week HoLEP Update (Dr. Amy Krambeck, Northwestern)

I wanted to provide a summary now that I've reached the three-week mark, since reading other patients' experiences was incredibly helpful to me before surgery.

Background: I'm 57 years old. My prostate was actually relatively small overall, but I had a very obstructive intravesical median lobe that functioned like a ball valve and caused significant bladder outlet obstruction. My PVR was over 300 cc, with bladder wall thickening from years of incomplete emptying. I had previously tried Flomax and finasteride and most recently was taking alfuzosin 10 mg plus daily Cialis 5 mg.

Dr. Krambeck performed my HoLEP in about 35 minutes under MAC (monitored anesthesia care--"twilight"--not general) without complications. Only about 7 grams of tissue were removed because my gland was small and the obstruction was almost entirely that median lobe.

Recovery: I was discharged the same day without a catheter after two successful voids in recovery, with low post-void residuals (31 cc and 74 cc). From the very first urination, my stream was dramatically stronger than anything I'd experienced in years.

I took one week off from work and returned on postoperative day 10. During that time I took it easy, but I walked daily. I kept my 32 oz tumbler full of water and sipped it throughout the day.

Over the first two weeks, I experienced what I would consider an uneventful healing course:

-- Mild burning that resolved quickly (I used pyridium for only two days)
-- Intermittent pink urine.
-- Several episodes of passing small, soft clots.
-- I had early discomfort with erections, presumably from irritation of the urethra and surrounding tissues from the scope, etc. That largely resolved after two weeks.
-- Around postoperative day 16, I had one larger episode of clot passage with brief bright-red bleeding. I rested and hydrated, and everything cleared. This seemed consistent with eschar (healing tissue) sloughing, which commonly occurs during the second-third week after HoLEP.

I never developed urinary retention, significant pain, fever, bladder spasms, or meaningful incontinence. My stream remained consistently excellent throughout.

Today (3 weeks): Urine is essentially clear, clotting has stopped, there's no discomfort, and my urinary stream is honestly astonishing. My bladder feels like it's emptying almost completely every time. What used to take me 3 to 5 minutes is now done in 15-20 seconds.

I have ramped up my physical activity and started lightly using my elliptical trainer a couple of days ago without incident. I've also started back with weights, but I'm not pushing to my previous levels quite yet. I haven't resumed sexual activity, as I was advised to wait at least three weeks, so I can't comment on that aspect of recovery.

I also want to emphasize that every HoLEP is different. Someone having 40–80 grams removed will likely have a different recovery than someone like me who had only 7 grams removed. Anatomy, prostate size, surgeon experience, and the amount of tissue removed all influence recovery, so my experience shouldn't be viewed as the expected outcome for everyone.

For me, however, choosing HoLEP has been one of the best medical decisions I've made. I hope this timeline helps reassure someone who is preparing for surgery or is in the early stages of recovery.