HoLEP procedure experiences?

Glad to read about your visit with Mayo Jackson. Would love to see responses from our community on HoLEP procedure. Thanks for posting.

I had the holep procedure done at the Jacksonville Mayo Clinic about two years ago. Doctor Dora performed the procedure with no complications. I’m 76 now with prostate cancer detected in 2017. The holep procedure was one of the best things I’ve ever had done. I had BPH for years and now can relieve myself like a 18 year old. Don’t worry about it, just do it. Doctor Dora is the best.

I completed HoLEP procedure a week ago. I was diagnosed 2019 with Gleason 4+4 prostate cancer and started Lupron ADT treatment. After 9 months side effects were to much and stopped.
Changed doctor and health plan 2021 and back on Lupron. Then April added Apalutimide (Erleada). 4 months later develpode serious rash on arms, back, and shoulders. Stopped Erleada and 2 weeks rash cleared up. HoLEP last week tissue analysis tested negative for prostate cancer!!!
What? Doing followup with my urology oncologist to find what it means. Meanwhile HoLEP a big success and worth it. Very low risk and worth it to get back normal uribnary behavior. Now will sleep through the night. I recommend it for sure.

First of all, WOW, and congrats on the negative test! Thank for for the encouragement toward proceeding - I’m hoping to get it scheduled soon.

I'm scheduled for a prostate mri there in a couple of weeks. Did you have an endorectal coil during your mri? How did that go? I wish you well on your procedure!

I did have an MRI (and a uriflow/ultrasound). I did not have an endorectal coil. The MRI took a while - I had the contrast done, so I had a port they injected that into. It was not bad. It was loud, even with the headphones. And I would recommend having a blanket - it was pretty breezy in the MRI machine. The amazing thing to me was you have the results available in your patient portal so quickly - including the actual scans!
Best wishes for a great result!

I had a HoLEP in September 2020. Done by Dr. Krambeck in Chicago. Her and her team did a great job and I had a great result. Be aware that another complication of urine retention is kidney damage. If you are retaining urine, it can back up from your bladder into your kidneys--not good. That is what happened to me before getting the HoLEP. That took care of my retention issue, but the kidney damage is permanent. Important to have a bladder scan on regular basis to make sure you are emptying your bladder.

Can you describe the procedure itself. Were you put out? I am 81 with BPH on meds . Any hospital overnight stays? Did you require catheter after for any period? Any side effects such as incontinence, lack of ejaculation or loss of erection?

As much info as possible would be appreciated. Thank you.

Sure. First of all, if you search 'holep' on this site, you will get lots of comments, replies, etc, all talking about pros and cons of holep, as well as descriptions and experiences. My own experience was that back in August 2020 I was ill with flu like symptoms, and had a blood test which showed a high number for creatinine. It is supposed to be no higher than 1 or so and mine was 5, meaning I was in acute renal failure. Ended up I was retaining urine in my bladder, and had almost 1000 ml in my bladder. I was in the hospital for 3-4 days while they got my creatinine down to an acceptable level. Not normal, but better. I had a catheter at that point, and had to keep using one after that. I decided to do self-catherization, which I found much better than having a bag and at least I was in control. Actually, for the first time in years I could at least urinate and empty my bladder on a regular basis. At that point I decided to have HoLEP rather than using a catheter for the rest of my life, which is also an option by the way. I was advised that while I may not mind doing this right now by myself, it might not be so good when I got older and needed help. The thing about HoLEP is you want a surgeon who has done a lot of them. Through a friend I found a surgeon in Chicago, Dr. Amy Krambeck, who probably has done more than anyone else in the U.S. I think almost 5,000 at the time. I had that in late September 2020, so was self-catherizing for almost two months. My wife and I drove to Chicago and stayed at a hotel. The morning of the surgery we went to the hospital and I was prepped and put to sleep, and woke up I think without a catheter. I know they put a small tube up your penis and use a laser through that tube to cut up a lot of your prostate--macerate I think they call it--and then use the same tube to draw that material out of you. One issue is whether you have any prostate cancer. If you do, that could be a problem as the process may help spread the cancer which is otherwise contained in your prostate. Anyway, I was in recovery for a few hours, until I could urinate. Back to the hotel for a few nights checking in with the doctor's people to make sure I was not having complications. I really did not have any. And I could urinate without any problem. I was a little sore, but not much. There was a little blood in my urine, and some from my penis, but not really that much. After a few days we drove home. So no overnight in the hospital, although I know some places that is what is done. I have not had to use a catheter since the surgery, and it is now almost two years later. I know incontinence can be an issue, but I have not experienced that. Funny thing, only when I hug my wife (really) do I have a little leakage, but not much. I did have a supply of Depends but did not have to use the much. I have had no problem with erections, but I do take taladifil, generic of Cialis, although I am not sure I really need it. More of a psychological help than anything. But about ejaculation. When you have HoLEP, it cuts off the tube through which your ejaculate get to your penis and goes out. So you do ejaculate, but it does not come out of your body. It is called retrograde ejaculation. You still feel the throbbing and enjoyment but not having it come out of your body and through you penis is a little odd and I probably do miss that but I have gotten used to it and would still have the HoLEP now if I had to chose. You do still get preejaculate, in my case a lot of it, and that does come out of your penis as usual. Not sure of the anatomical difference why it does come out but not ejaculate. Should you have HoLEP? Not sure but it has worked out for me. There are several other options, one of which I considered doing. That is arterial embolization. Here is a link to some info about that: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/prostatic-artery-embolization#:~:text=Prostatic%20artery%20embolization%20(PAE)%20is,benign%20tumor%20found%20in%20men.

I thought about doing this, but at the time I was not confident about it and whether there was a doctor who had enough experience with it. I believe I have heard it is done more commonly now, and might be a good alternative which I assume does not affect ejaculation. Not sure if it is as permanent or complete a solution as HoLEP however.

Whatever you do, I hope for a good result. Take care.

I forgot to mention one thing. Although the HoLEP solved my urine retention and urinating issues, I ended up with Chronic Kidney Disease (CKD) Stage 3B as a result of the urine retention causing urine to back up into my kidneys. I believe this could have been avoided if my urologist at the time, who knew I was having urinating issues, had regularly done bladder scans. This is a simply procedure where they do an ultrasound of you bladder by rubbing the wand on your belly after you urinate to see if you are emptying your bladder. A simple non-invasive procedure. If you are not having this done, insist they do this every 3-6 months or so to make sure you do not end up with the same problem I did. Urinating problems will not kill you, but CKD will.