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My Background & Upcoming HoLEP — Would Love Your Insights

Posted by wavelight2020 @wavelight2020, Jun 2 10:19am

Hi everyone. I've been reading through this forum and am impressed by the depth of experience here. Wanted to introduce myself as I prepare for surgery this summer.

About me: 57-year-old, otherwise healthy male (BMI ~23). Progressive BPH/LUTS for several years (weak stream, straining, incomplete emptying, frequency, nocturia). IPSS 23 (severe). Currently on alfuzosin and tadalafil; previously tried tamsulosin and finasteride, both discontinued due to side effects.

Key findings: Cystoscopy showed a significant intravesical median lobe. Prostate ~40-50 cc on CT. Post-void residuals climbing into the 300+ mL range, and my latest renal ultrasound showed mild left hydronephrosis (likely from the outlet obstruction and drinking too much fluid pre-study). Bladder wall thickening also present. PSA consistently low (~1.0–1.2).

The plan: Scheduled for HoLEP with Dr. Amy Krambeck at Northwestern on July 10. I'm fortunate to be only ~2.5 hours away in central Illinois. Plan is outpatient, catheter-free discharge, with a hotel stay the night before and after as a precaution. I am trying to get mentally prepared for the recovery timeline, including (hopefully) transient incontinence and retrograde ejaculation.

Questions for those who've been through it:

1. For those with a prominent median lobe as the main component… did your recovery or symptom improvement differ from what's typically described?

2. What was your real-world timeline for regaining continence and ditching pads entirely?

3. Practical recovery tips you wish someone had told you beforehand, like pad recommendations, managing urgency spikes, activity pacing, etc.? I love exercising and use my elliptical five times a week and do weights 2-3 times a week. Laying off will be tough, but I know necessary.

4. For outpatient/no-catheter discharges, how did the first 48 hours go? Anything catch you off guard? When did you start taking some casual walks around the neighborhood?

5. How did you handle the caffeine restriction? I usually drink 2-3 cups a day. How long before you reintroduced coffee, and did it make a noticeable difference? How about soft drinks?

6. For anyone with elevated PVRs (300+ mL) pre-op, how quickly did emptying improve?

I'll be honest… I'm a bit nervous about all of this. Reading testimonials about prolonged incontinence and regret on this Forum has been sobering. Also, a couple of years ago, I had emergency kidney stone surgery that went sideways due to a surgical complication (sub-optimal surgeon), and that experience left a mark. I know there are no guarantees with any procedure, but I've done my research, I feel confident in Dr. Krambeck and the team at Northwestern, and at this point, there's not much more I can do except prepare and trust the process.

Thanks in advance. I'll continue reading existing posts and plan to share my own experience as I progress.

Interested in more discussions like this? Go to the Men's Health Support Group.

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alfonse | @alfonse | 4 days ago
In reply to @wavelight2020 "@alfonse My pre-op PVR was over 300 cc, so I understand the concern. Fortunately, my first..." + (show)
Profile picture for wavelight2020 @wavelight2020

@alfonse My pre-op PVR was over 300 cc, so I understand the concern. Fortunately, my first two voids in recovery were measured before I went home, and my PVRs were only 31 cc and 74 cc, which was very reassuring. Since then, my stream has remained exceptionally strong, and my bladder feels like it's emptying almost completely.

My surgeon's office has been responsive to questions through the patient portal, but my formal follow-up is also at three months with Dr. Krambeck's PA. From what I've gathered, that's fairly common after an uncomplicated HoLEP.

If you're worried about whether you're emptying, it certainly wouldn't be unreasonable to send your surgeon's office a message. I'd think arrangements could be made for a quick bladder scan. Personally, I'd rather ask than spend weeks wondering.

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@wavelight2020
OK, that’s good to know. I guess three months follow up is common from what I read as well. However, my Post surgery PVR was 274 the first time, because I was afraid to push. The second time it was 147 so they decided that that was good enough. I sent the surgical team a message. Let’s see what they say. I’m on day five and the flow seems to be getting better. My main concern is the fear of developing another bladder stone. I definitely don’t want anything else going up my urethra for a long time! But from everything I researched it seems like I’m right on track. I’m glad you were able to go back to work. I know you mentioned you had some more blood in your urine. Which is obviously going to happen when you’re moving around more. We can have some bleeding even months from now. I have no problem laying down. I slept all night with no incontinence issues. I didn’t have to get up in the middle of the night to urinate. Walking around is not a problem. It’s sitting down that kills me. I guess I need time for that raw tissue to heal. Again, thanks for all your info. I’m sure we’re not only helping each other, but hopefully everyone else.

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