Is HoLep recovery worth the procedure?

@runningold I'm going on four years post HoLEP. Prior to HoLEP I had a Urolift which from my perspective did not help, my surgeon said I was emptying more volume. About a year later he did Laser Greenlight procedure. It was amazing, I peed a very strong, long stream. I was happy... for about a month and then it reverted, frequencies, urgencies, slow, dribbles, etc. That surgeon referred me to another surgeon to do a robotic procedure. I should mention that over 10 years several urologists told me they never saw a faster growing prostate. The newest surgeon told me I was an excellent candidate for HoLEP, and sent me to that surgeon. She was great, explained it all in graphic detail and we went forward. They kept me overnight for observation and removed catheter that morning. I was peeing like a fire hydrant and aside from a couple of scares from blood clots that were a little stubborn, to be expected, I had no other issues. Life improved greatly. I will say that now if I have a third cup of coffee I may have some urgency/frequencie for a few hours. I'm 69. What does your surgeon say about your stream and inflamation? I suppose it's possible. I hope things improve for you soon.

I had HOLEP in December 2024. Surgery went well as far as I knew. I have had 10 UTI’s and still have incontinence. Had an appointment with my urologist and he had another urologist with 30 plus years of experience do the cystoscopy. The last cystoscopy was February 2025. This urologist noticed an issue with my bladder neck that is not allowing my bladder to fully drain and the cause for my UTI’s. I am going in for surgery over the next couple of weeks for a TURP to correct the bladder neck. Both urologists believe this will stop the infections and allow me to completely empty my bladder. My urine stream never got better after the HOLEP. Praying this will correct all my issues so that I can get on with my life.

I am a 66 year old active male. I had an almost complete blockage from my prostate that was measured at 6x normal size. It affected my kidneys so bad, I almost went into complete renal failure. My eGFR was 15, just right on the cusp of complete failure. I could still urinate, but, obviously I wasnt urinated enough. Went to ER, had catheter installed after about the 6th attempt causing bleeding for a week. Wore catheter for 6 weeks while waiting for HoLep procedure with Dr. Lawrence Tsai. This is the first day after procedure, catheter came out this morning.(Yay). Urine clear, but starts slowly since it's only been one day. There is alot of trauma and swelling in that whole area making defecating painful when passing behind prostate. Also, when this occurs, I actually have an erection, and this is extremely painful, taking my breath away. All of my abdominal muscles are getting quite a work out, as they are sore. I am just gonna have to ride this out, as it's the first day after my surgery, but, I am hopeful. I will update as we go along.

Not worth it for me. I’m a fit 72 and had HOLEP June 2025. I still have persistent leakage 8 months later. Significantly worse quality of life than pre op. After 20 years of planning life around restrooms I decided to plunge ahead with Holep. Went to large practice in Madison Wi and signed on with the first surgeon available. Did not do due diligence but was reassured by the initial interview. I knowingly accepted the remote risks of persistent incontinence.

I was not given a lot of info pre op about Kegels etc. Post op healing after first week seemed normal. Unfortunately I experienced significant leakage from the get go. Discussions with office were either dismissive (takes time…you were told about risk, etc). Did my own research on Kegels etc and was all in for months. Gradual improvement but plateaued at a frustrating level of wearing pads and depends constantly.

Finally referred to pelvic floor PT after 5 or so months. Supportive but nothing new. Actually suggested I cut back on my 6x10x10 daily exercises.

So I’m stuck with an outcome I find entirely unsuccessful. I have better urinary performance than before but the constant dampness with pads etc. is miserable. Limited ability to return to active fit lifestyle. Wouldn’t dream of going near my wife for intimacy since I feel so gross.

Life is miserable and I’m angry with my practice’s dismissive attitude. They seem to feel I was a successful outcome. Only suggestion is to wait until a year is up and then consult for Artificial sphincter. I’m obviously reluctant to let this practice touch me again even if I pursue this.

Any suggestions guys?

@hhibird So very sorry about your outcome. Get another opinion from the best in your area. Get an appointment with Amy E. Krambeck, MD at Northwestern to see what you can do. Don't give up!
https://breakthroughsforphysicians.nm.org/holep-semi-live-surgery-performed-by-amy-e-krambeck-md-case-2.html

@hhibird I am sorry to hear about your experience. It should not be like that at all. It makes me want to steer clear of HoLEP.
Last night I was watching videos about kegels and learning to do them properly. One of the videos had a doctor interviewing a physical therapist. If I understand correctly, the physical therapist said that you can do kegels too much and not get the results you want. He also recommended stretching the pelvic floor muscles to get them to relax. I take the information on YouTube with a grain of salt and compare with other sources, too. If you want I could look through my video history to find the video.

Scheduled for HoLEP next week and I'm beccoming quite anxious after reading some of the posts here. Having procedure done at a top Boston hospital. My Urologist is highly experienced in HOLEP and claims to have done ' literally thousands' of them. Early 70's, healthy, taking max dose of Flomax and currently urinating fine during the day, but up every 2 hours during the night and often have trouble starting especially after even one alcoholic drink. I have had two episodes of retention that required visit to ER in 4 years, both preceded by a meal and a couple of pints. Dr. did go through the pro's and con's of all the established procedures, but really pushed HoLEP as the gold standard. He did caution there may be slight pain and leakage for maybe 2 weeks with only 1% risk of long term problems. The last ER episode convinced me to go ahead with the procedure ASAP. Reading some of the posts here I am hoping I am not being premature in going ahead with this as my condition is not as severe as some here.
I suppose I'm posting looking for some reassurance that all will go well. I will not be happy if I end up with painful urination or leakage for more than a week or two.
I will try to post updates on my post procedure progress.
Thanks for reading.

@oldfiddler thanks for your interest and reply. Since not doing due diligence on my surgeon selection I’ve been consumed by research on post op incontinence. I’ve done everything I can to do the work indicated by myriad info sources and my PT staff. It seems persistent incontinence may be related to surgeon experience and time of rectoscope insertion. That may be on me for rushing in to procedure. I just want prospective patients to weigh the slim risks against the misery if you fall into the tails of the risk distribution.

@hhibird I’m hoping for a good resolution for you. I really appreciate what you say about due diligence.

So far, I’ve only talked with two TURP surgeons. The first one made me feel uncomfortable and the biopsy he performed was very painful for a couple of days. The second one said she wouldn’t do as good of a job as a HoLEP surgeon.
I am waiting to get contacted by this doctor.

I only know two questions to ask. “How many have you done and what is your complication rate?” I am sure there should be more questions but I don’t know what they should be. Any hints or suggestions by you, or others, of what to ask are greatly appreciated and will be helpful to other readers who are on this journey.

Yesterday I woke from a bad dream about dying and had a lot of pain in my prostate area. I guess I should do some more research and choose a doctor and procedure soon.

@cotidiana

FWIW, I had a successful HOLEP surgery in March, 2024 with Dr Matthew Dunn at UCLA who has also done thousands of them with a very low complication rate. I did not have the leakages beforehand that some people here have reported. Mostly it was a weak stream, occasional blood in my urine, consistent pain when peeing, frequent nightime urgency, and five years or so on Flomax, which was starting to fail as a solution. As I've mentioned elsewhere on these boards, it turns out I had hundreds of prostate stones that he removed, which seems to have been an issue since I was a child. The recovery has been pretty much as reported and I'm happy with the results. Not sure if that reassures you or not, but keep us up to date here after your procedure.