Is HoLep recovery worth the procedure?

Had HoLep at the end of September 2024. 69 years old, symptoms of BPH with 55 cc prostate large median lobe. Surgery went well no pain and catheter out by 7am the next morning. No problems urinating strong stream no pain went home at 1pm. Over the next few days some blood and stinging when urinating but it cleared up fast. No incontinence at all. At about 2 months out I noticed that I had to use the bathroom more frequently and urine stream got much weaker. At the 3 month check up the uroflow exam showed a problem and ultrasound sound showed over 300 ml urine retention. Last week an in office cystoscopy showed a bladder neck contraction. Now scheduled for another surgery to resect the contracture on March 7th. The possibility of this type of complication was never discussed with me prior to surgery and at this point I don’t know that I would recommend HoLep.

First glad you had some relief before the setback. I’m in the glory stage. Everything that’s been tested is back to complete normal accompanied by occasional mild burning and perennial numbness. I’m keeping my eyes open for post infection, relapse or blockage. I’ve been fortunate thus far. Hope you heal quickly

69 year old. BPH was previously being managed by medication but not to my satisfaction. Had HOLEP at Mayo Jacksonville in late October. Rough few days but started feeling better soon after and continued to improve. Followed all protocols. Had minor incontinence but was improving. One month in and things changed for the worse - pain when urinating, pain at prostate, very frequent and intense urgency to urinate, not emptying bladder. Discussed with medical team and they said that this sometimes happens and to just stay the course. Had a urine culture done to rule out UTI - was negative. They were right. Now 3 months post op and things are so much better. Very minimal (if at all) incontinence, great stream, no pain, emptying bladder, no intense urgency. Every surgery is different, everyone heals at their own pace. Overall a great surgical experience if you can call any surgery "great".

Marvelous!! I’m getting paranoid reading others different experiences. At this moment there’s a mild numbed/sting that lasts up to 30 seconds. Day 10-11 everything is normal. I just can’t run yet. Don’t want to anyway

69 year old, very fit, healthy.
Most recent PSA of 9.1 PSA has been >7 for 15 years.
Two biopsies and two MRI's; No cancer detected.
Problems emptying my bladder easily. Waking as many as 6 times a night to pee.

I had the HOLeP procedure on late September 2024 under general anesthesia in Charlotte, NC. Catheter removed the next day. Bladder filled prior to removal. Voided 260ml. Went home and drank two full glasses of water, thinking that all was well but ended up almost peeing myself an hour later. But that was my fault. I should have gone a bit slower instead of overloading my bladder.

Pathology showed NO cancer cells in prostate tissue removed during procedure.

Minor incontinence (occasional random leaking of a few drops) during the daytime, used pads for two week, then used small shields for a few more weeks. No nighttime incontinence.

Urine stream very good. No pain. No blood clots or scabs (later). Doc said that's normal but they prepare everyone for the worst case.

Waking 3-4 times per night to pee during the first month, but I think it was just allowing my bladder to learn to hold urine. Prior to procedure, I was able to pee but only a dribble and then it took sitting and waiting as long as 20 minutes to finally dribble enough to go back to bed. Measurements at doc prior to procedure showed retention of 260ml post void!

After procedure, I am definitely able to completely empty my bladder when I peed. I have found that I do need to push the final bit of urine out before I finish, to avoid post void dripping. I've been doing Kegels but probably not as aggressively as I should have been.

Urgency and frequency are diminishing as time passes. Overall, I am very very satisfied!

My only challenge is that I leak when sexually aroused, which is a problem. Orgasms are as strong as before procedure but completely dry (and this really depends upon how much prostate tissue is removed during the procedure. My prostate was 112cc; surgeon removed 85cc of tissue.) Using an elastic ring around base of penis when aroused prevents leakage, but I am hopeful this will resolve eventually. If not, I will seek a referral to a pelvic floor physical therapist (I have discussed this will doc).

Give yourself time to heal, relearn how to hold your urine and manage your new normal. Complications are actually rare statistically. Again, I am very very pleased to have had the HOLeP. So thankful that we have a very kind, experienced and competent surgeon here that has performed 700+ of these procedures.

I have leaked about once a day , I usually notice after I sit or lay down but a few drops at most so far. My bathroom frequency has completely dropped from 4-5 times an hour (also 20 minutes or more just trying to empty enough to go back to sleep for an hour to repeat the proces). . 1/31 was my procedure. As of right now 2/11 I only occasional mild numbing slight burn that subsides in 20 seconds.
I can’t say I’ve experienced any complications since I’ve been released from the hospital. The doctor says it’s rare for no side effects. But time will tell if I suffer from retrograde.

Best wishes to you as you recover. As for the issue of retrograde or dry ejaculation, that will mostly depend upon how much prostate material was removed during your HoLEP procedure. That's because the prostate material is necessary to propel semen out of the penis during orgasm. Some surgeons remove more than others.

Removing more material will almost certainly prevent semen from being released during orgasm. Those patients who do report a return to full or partial ejaculation after HoLEP are most likely those whose surgeons removed less material.

I wanted to have as much prostate material removed as possible (to ensure that I would never need a revision of my procedure due to regrowth, but also to lesson the possibility of prostate cancer later in life), and that was my surgeon's standard practice, but I also knew that it would render my orgasms dry. And although that has been the result, and I do miss the sensation of ejaculation, I am happy to report that my orgasms are now as strong, maybe even a bit stronger, than before my HoLEP.

Again, best wished for a speedy recovery!

Happy to hear you are happy with yourself and your choice to have the HoLep. Many regret, any kind of prostate surgery, especially if it interferes with what they are used to. Don’t quote me in case I’m wrong. From what I can see in the photograph, they removed a lot of of it. My doctor did recommend I remove all of it just because it’s the safest way to make sure 100% no reoccurrence and other things, etc.. after sticking the camera to look inside he informed me that I did have a choice because only 10% of men have it in a certain way that they only need to remove what I think was the median lobe which was causing the obstruction more than the prostate itself, but in conjunction with the prostate created 100% blockage.
So in conclusion, I’ll have to wait for the next rainy day after another week or so before I find out if I’m dancing under the raindrops

16 days Post Op.
Bathroom breaks have remained way fewer than before. Initially once every 4-6 hours ( big difference from 4-5 times an hour) Now 30-60 minutes after drinking anything I go twice but an hour apart then not for hours!! Very strong flow. After 2 weeks visits are a little more frequent but bladder empties. Strange sensation still lingering from the cystoscope and then the holep. Subsides into a numbness. No more blood since last week and then just a little from walking all over the city and possibly driving , which is forbidden 🚫. Don’t do it.