HoLEP procedure experiences?

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.

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.

Thank you very much for sharing. I have also looked in to PAE as an option. One last question. I hope you are not offended but "How old are you". A no answer is fine if you wish.

Thanks again very much..

No problem at all. I’m now 71 1/2. I had had an enlarged prostrate and high PSA for many years. I have had numerous biopy and MRI testing for prostate cancer and so far none has ever been found. For years, I took a medication to shrink my prostate, which worked well. They had other side effects. I did not like. So I switched to a different one that helped me urinate w/o the side effects, but allowed my prostrate to grow which I think led to my urine retention issues.

Thanks again for sharing.

So far I have had many tests (PSA , PSA Free, CT scan, MRI) but no actual procedures. TAKING one .4 Tamsulosin/Day that works with symptoms.

Still just monitoring. Considering Rezum originally but now added HOLEP as possibility. In the end ...maybe nothing as long as Tamsulosin works.

Would anyone be willing to share their experience after HoLEP - I have mine scheduled for next month. It sounds like the procedure is one morning, get the catheter out the next morning, stay in the area for another 24 hours, then head home. Some of the things I wondering are: How soon after did you return to work? (I basically have a desk job...) What was the pain level like? Did you have to "re-learn" how to urinate? Any pointers? Thanks in advance!

Hello @southgeorgia! I live in central Florida, and had the HoLEP Procedure in April of 2022 at the Mayo Clinic in Jacksonville. It sounds like you have been scheduled the procedure and it’s right around the corner! I arrived at the Mayo for some preliminary tests the day prior to the procedure, like EKG, Bloodwork, etc. the following day I went in for the procedure. The following morning the Foley Catheter was removed, and I too remained nearby for another 24 hours. This is because I live 175 miles away, the Doctor felt it would be better to remain nearby in the event something came up. Once the Foley was removed, I felt so much better. The only pain I had it seems was while the Foley was in place….it was uncomfortable. I did take it easy for about 2 weeks, nothing strenuous. I am retired so I basically stayed at home and followed Doctors orders of no lifting. I used to have a desk job, so to answer your question, I don’t think it will be an issue for you. I would ask the Doctor to make sure. No sir, I didn’t have to “re-learn” how to urinate, there was no pain when I did urinate. I was hugely surprised at well I could urinate as soon as the Foley was removed. The Doctor will tell you what to expect, listen carefully to what he says, follow his directions and you won’t have any problems. I feel so very lucky to have chosen this procedure because it worked out beautifully. This forum is a great tool to learn from others as others will learn from you. I’d encourage you to keep this group informed on your experiences, it helps all of us! If you have any other questions, please ask and I’ll do my best to reply in a timely manner! All the best!