My Background & Upcoming HoLEP — Would Love Your Insights

I had prostate surgery in 2020 or 21 from Dr. Cranbeck. She and her team were amazing. Had a wonderful result. I have RE which has never really bothered me although I do think there’s a little something missing-to be blunt, the feeling of the seminal fluid surging out of your penis. However, the actual surge or ecstasy of the orgasm is still there and that’s the most important thing. I have noticed recently that their apparently is something called EP Holep which it sounds like doesn’t cause retrograde ejaculation. I would not change anything but if true it’s an interesting development.

@paul55

EP- Holep preserves, i.e. leave intact, certain parts of the prostate tissue, to preserve antegrade ejaculation.This means the prostate will grow back quicker. The standard Holep hollows out completely all the prostate tissue inside the prostate capsule leaving nothing to grow back quicker enough to require another Holep unless one lives to a 150!
https://link.springer.com/article/10.1007/s00345-026-06348-7

@heath2026 Interesting info. Although my surgery was a fairly easy experience, not sure I would want to have to go through it again.

I had two green light laser PVP procedures and a Rezum steam procedure before finally getting a HOLEP. I wish I had undergone the HOLEP first. It is hard to predict what recovery will be like for any individual as there seems to be a good bit of variation from person to person. My immediate post op and first few weeks were not all that different from the green light laser PVP. My surgeon explained that the more severe my BPH and longer I went without relief the slower my recovery and improvement. It took me 6 months to feel back to normal By one year I found I could nearly sleep through the night and was only getting up once to pee. I did not need pads except for the first week or so. I experienced leaking when straining for a few months but this went away by six months. Although I was not as actively exercising as you, I had resumed all my normal physical activities within three months. Finally, I had great confidence in surgeon and care team and feel this is vitally important to a good outcome.

Questions for those who've been through it: - I've been through it and I did a HoLEP 6 weeks ago. However, at your age and at your retention level, did you consider Aquablation? The reason I chose HoLEP is my retention was at 500ML and I was worried about damaging my kidneys and at 68 it was a toss up between the two because Aquablation provides you with a much better chance of preserving ejac. HoLEP was a more definitive procedure with my median lobe causing the blockage, prostate size was 64G. To this day I hope I made the right choice.

1. For those with a prominent median lobe as the main component… did your recovery or symptom improvement differ from what's typically described? Yes, almost immediately, some blood for 2+ weeks then gone. At my 4 week post-op my retention was down to 21ML

2. What was your real-world timeline for regaining continence and ditching pads entirely? I used pads for 1 week.

3. Practical recovery tips you wish someone had told you beforehand, like pad recommendations, managing urgency spikes, activity pacing, etc.? I love exercising and use my elliptical five times a week and do weights 2-3 times a week. Laying off will be tough, but I know necessary. YES, you have to - I do the same and lift too - Don't do anything except walk for a few weeks. Week 4 - back in the gym,

4. For outpatient/no-catheter discharges, how did the first 48 hours go? Anything catch you off guard? When did you start taking some casual walks around the neighborhood? 2nds week started walking. My URO kept the catheter in for 3 days vs. the standard 1 day, not a big deal.

5. How did you handle the caffeine restriction? I usually drink 2-3 cups a day. How long before you reintroduced coffee, and did it make a noticeable difference? How about soft drinks? I drank coffee as usual but avoided carbonated stuff

6. For anyone with elevated PVRs (300+ mL) pre-op, how quickly did emptying improve? Right away for me.

@markbph1 Do you have any regrets about your choice at this point?

My situation was a little different from yours. I’m 57, my PVR was lower at roughly 350 cc, and my prostate was considerably smaller, but I had a very obstructive intravesical median lobe that was essentially acting like a ball valve at the bladder outlet.

I did consider Aquablation. I actually thought about getting a consultation in the northern suburbs of Chicago, but once I had a long discussion with a urologist I trust deeply, I moved pretty firmly into the HoLEP lane. He is the chairman of a university urology department and, although he personally performs more traditional procedures such as TURP and Rezūm, he strongly encouraged me to look at HoLEP because he felt it was a very definitive option for the anatomy I had.

For me, that was the deciding factor. I wanted the most definitive solution I could get, especially with a large intravesical median lobe creating the obstruction. I ultimately went to Northwestern for HoLEP and have had zero regrets.

The retrograde ejaculation issue turned out to be a complete nothingburger for me. The orgasmic sensation and intensity are the same as before surgery, and I honestly do not care about the lack of visible ejaculate. Once I experienced it and realized that everything still felt completely normal, the psychological concern disappeared.

Everyone has different priorities, and I completely understand why preservation of ejaculation might push someone toward Aquablation. In my case, though, I wanted durability and definitive relief from the obstruction, and HoLEP has given me that. My urinary function is dramatically better, I’m off the alpha blocker, and I couldn’t be happier with the outcome. It has given me a lot back.