My Background & Upcoming HoLEP — Would Love Your Insights

Had Greenlight in 2012 but as expected, prostate will regrow. So had HOLEP on 19 June this year. Should have had it earlier, eg last year. I am on day 30 (past the 4 week 28 day window rehab), and it has been a BREEZE. NO PAIN since I woke up from the procedure on late afternoon June 19.

Was on cathether for about 40 hours; I was detached from the machine the morning after Holep, and allowed to walk around with the "bag" - showered, peed, etc, carrying it with me. Cathether (bag) was removed at 5:30am on the morning (Sunday) I was discharged.

Unlike Greenlight, Holep recovery is very uneventful eg in the 28 day window of rehab, no pieces of dead prostate tissue was passed out from bladder, unlike Greenlight. In Holep, all prostate tissue enucleated from the prostate capsule, is "vacuumed out" as part of Holep. The inside of the prostate capsule has a totally smooth surface after the overgrown prostate tissue is removed. There is nothing to pass out of bladder following Holep. No so in Green light because the lasered off tissue is left in the bladder for the body to eject it over the next 4 weeks - can be unpleasant as an over size dead tissue can act as a temporary BLOCKAGE on and off during the 4 weeks. Green light (as well as TURP) can be considered as "primitive" and barbaric in 2026. TURP is still around because the urologists who have learnt are older surgeons, who don't want to learn Holep which is much more complicated. Also the Holep equipment is very expensive while TURP is a cheap procedure not requiring sophisticated equipment.

Here is the 28 day time line of recovery.
Holep was on afternoon of June 19. Stayed 2 nights at hospital. Left at 10am on Sunday 21 June.
Day 2 (catheter removed) - clear urine until day 18
Day 18-day 22 - rusty red tissues color the urine a light color (this is the "shedding phase" of Holep - the internal surface of the prostate capsule, after being "carved clean" by Holep, has regrown its skin cover, hence the shedding of scar tissues.
Day 23 to day 25 - on and off rusty color at start of stream
Day 26 onward to now - 100% CLEAR urine flowing like NIAGARA FALLS!

Up to day 27, used 2 x Depend Level 3, daily.
From day 28, using 2 x Depend Level 1.
I expect to ditch the depend completely somethime in the next 7 days!

Went for a short run on day 28, wearing a Level 1 Depend which wasn't even needed. NO leakage during 1.5 km run. No urgency post run. For once, no blood in the urine after a run. That was the main problem before Holep because the regrown prostate, was hitting the bladder neck when I was running. Prostate tissue that regrows is not the same as the original tissue - it is very fibrous and susceptible to BLEEDING. I had seen a live view, during CYSTOSCOPY, 2 years ago - the regrown prostate prostate (from Greenlight in 2012) is like a cave of lobes of flushed red prostate tissue, in a very chaotic format!

After Holep, it is a smooth, completely cleared prostate capsule, with no tissue left in there to keep growing back, and needing another procedure in 10 years time.

THERE IS NO PAIN at all. I took 2 aspirin, when I woke up from anasthetic only because the nurse offered me. I didn't need it and refused more offered to me. Also, no constipation problem, in the hospital and since rehab at home in last 4 weeks. I took 2 "anti constipation" pills given to me, in my 1st 24 hours, and none after that.

I brought my Apple devices with me to hospital, with charging cables and extension cords to let me recharge them as I kept myself entertained on US Talk Radio, as well as country music eg. http://www.hpr.org/ ENJOY 🙂

My surgeon was Dr KAPIL SETHI. He is a modern day "Einstein"!

Went for walks, up to 9km walks, from 2nd day back home. UNEVENTFUL. Urine remained clear after walk. There was no bladder incontinence emergency while I was out walking! Do walk (gently). Do not "do nothing" like a potato couch. Gentle walking is strongly recommended. But remember, no gym work, lifting weights, or any vigorous exercises. The pelvic area, the bladder, and prostate like to be left alone without vigorous jumping, tensing etc from impact exercise, or core exercise of the torso.

Stay clear of coffee in the 1st 2 weeks, and gradually introduce it after that. During the day, drink lots of water - sipping a little each time instead of drinking huge amounts like drinking beer! Drink less water after 7pm.

@markbph1 thanks for the feedback. How long were you advised to wait before attempting ejaculation?

I think 4 weeks but I will be speaking to my doc shortly

@medinfo1

It is day 30 for me post Holep on June 19, just over 4 weeks ago. It has been an UNEVENTFUL recovery. Absolutely NO pain from the moment I woke up from anastetic on late afternoon of June 19. Clear urine from the moment catheter removed at 40th hour post Holep. From days 2 to days 18, 100% clear urine. Days 19-22 saw some rusty brown color - expected part of recovery as the inside surface of prostate heals, and shed its scar tissue.

As for bladder incontinence since Holep, 2 x Level 3 Depends from day 2 to day 24. Then I switched to 2 x Level 1 Depends. Been out for a run on day 28. No problem. No urgency to wee during run! Urine is gushing like Niagara Falls. No more blockage!

I just had HoLEP surgery three days ago from Dr. Mitchell Humphries at Mayo Clinic in Phoenix. So far better than what I expected. My urine flow is effortless. A little bit of stress incontinence when I move around. But I know this will most likely go away once the inflammation goes down. I too was afraid of retrograde ejaculation. We shall see. I’m not sure if you’ve ever taken Flomax (tamsulosin). For me, it caused the worst retrograde ejaculation But it also relaxes the pelvic floor muscle muscles. So there was no contraction at the orgasm. The feeling stopped as soon as it started. I’m thinking and hoping this is going to feel more like a regular orgasm. Just nothing coming out forward. But I was retaining urine and creating bladder stones. I had some moderate damage to my bladder. If I didn’t do something about it, I probably would have no control of my bladder in the future. I know there’s other options but I am 59 years old and don’t feel like having surgery again or put back on medication in 10 to 15 years. Best long-term studies show the best results with HoLEP surgery.

@alfonse congrats on your recent successful surgery. It sounds like we are in similar boats when it comes to age, need for intervention, recovery timeline and future “concerns“. I have taken Flomax in the past and discontinued it because I had the same experience you did. This is an interesting reply I received when querying Open Evidence:

“The Flomax Experience Was Likely Different From What Post-HoLEP Will Feel Like”
This distinction is important. Tamsulosin-induced ejaculatory dysfunction is now understood to be primarily anejaculation (failure of seminal emission) rather than true retrograde ejaculation — it acts on seminal vesicle/vas deferens contractility and possibly central 5HT1A/D2 receptors involved in the ejaculatory reflex itself.  This means tamsulosin may have been blunting the entire ejaculatory reflex arc, including the rhythmic contractions that contribute to orgasmic sensation. Post-surgical retrograde ejaculation is mechanistically different — the ejaculatory reflex and muscular contractions still occur, but the fluid goes backward through an incompetent bladder neck. The neuromuscular "pump" that generates orgasmic sensation remains intact. 

Let’s hope you are correct. Flomax is an alpha blocker, relaxing, smooth muscle tissue. Relaxing the bladder neck is what causes retro ejaculation. However it’s not selective enough just for the prostate. Therefore, it also relaxes the pelvic floor muscles, and you barely get a contraction to feel a full orgasm. Fingers crossed.
I’m curious, where did you find this information? I’m actually a healthcare provider and would like to look more into it.

@alfonse https://www.openevidence.com/