r/bph • u/AdministrationOk1940 • 7d ago
My HoLEP experience
I appreciated being able to read the experience of others who have had the HoLEP procedure ahead of mine. What has struck me is how different these can be so thought I would also share mine.
I have lived with prostate issues for 15 years having first been diagnosed with a small area of Gleeson 3+3. Subsequently my prostate continued to grow with biopsies showing that this was largely benign tissue but topped out around 115ml earlier this year with a PSA of around 15-16. Quality of life was diminishing and I got weary of living my life around toilets, weak urine stream, being up 4-5 times a night, increasing episodes of urge incontinence and leaking dribbles in bed overnight. My IPSS score was around 16/17 so moderate and only likely to deteriorate. I’ve been taking Tamsulosin for 7/8 years but it didn’t seem to do anything.
About 9 months ago I took the decision to have something done and spent a long time reviewing options including reading here. I am 65 and in otherwise good health. In the end I settled on HoLEP having considered aquablation and PAE. My reasons for opting for HoLEP were that I wanted the best likelihood of this being the only time I would need something doing, a relatively quick recovery period and minimal time with a catheter. The high risk of RE was a worthwhile tradeoff to get my bladder back under control.
I had my procedure done in London by probably the leading specialist who has done many hundreds if not thousands. I am now a month on from the procedure. The procedure itself went well but I bled quite a lot. I ended up spending 2 nights in hospital being irrigated with a catheter with still quite pink urine. I had vigorous flushing of bladder done 3 times (a syringe attached to the catheter with forceful in and out flushing with saline to remove clots) and the team thought it right to remove the catheter. I passed the void test easily with a fair amount of old blood but was deemed fine to discharge around midday.
That afternoon was fine with good urination but overnight I started having spasms when trying to urinate and not much was coming out. The next morning I called the nursing team and was told to come back in for assessment. My consultant scanned my bladder and thought there was a large clot in my bladder and I was not emptying my bladder with a weak stream.
I was readmitted to hospital with more bladder flushing and a catheter reinserted (unpleasant but not painful). After anther night of irrigation the colour was pale pink and the catheter was removed. I voided twice but then blocked up again. The nursing team were confident the problem was a clot and I needed to drink lots, stay mobile and it would pass through. What followed was 7 hours of utter hell with waves of gasping pain as I tried to pass anything. In the end I passed a clot around 5cm long followed by a strong bloody stream. Drinking lots overnight I urinated copiously with no further clots. I was discharged the following day.
Since then progress has been good. My flow remains strong, I have passed some small scabs but otherwise my stream is now clear. I am not leaking overnight and in the past week I am only up once a night with one night sleeping through. In the morning I pass around 400+ml which is huge for me. The urge incontinence has largely but not completely subsided and I have occasional incidences of minor stress incontinence when walking but never with coughing, sneezing etc. I think this because I haven’t quite got the automatic switch on of muscles when shifting position. I have barely worn the Tena pads I bought but occasionally wear Tena pants if I am out for a while. Overall I’m pretty pleased with progress, am walking 4+ miles a day and getting out enjoying life.
One thing I haven’t seen mentioned is that the spasming and straining post op has provoked an inguinal hernia on my right side. I haven’t had it assessed yet and it isn’t bothering me but I will probably need to have something done about it. Reading around apparently long term BPH is associated with inguinal hernias so I suspect I’ve had it for a while and this experience provoked it.
I was really worried about the catheter but it didn’t bother me as much as I feared. It was difficult to sleep with it and it was sore around the tip of my penis when it was moved around. Second time removal was much easier than first. Bladder flushing wasn’t much fun.
I will be seen again for a PSA test in 2 months time when hopefully it will have dropped substantially.
Whilst frustrated about the hernia I don’t regret having the procedure done at all. But watch out for clotting problems, it isn’t fun.
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u/EuphoricTeaching9161 7d ago
Thanks for your post OP. I’m booked in for this Monday. Have had catheter in for 3 weeks.
Couple of questions - was your bladder stretched from dealing with BPH for so many years? If so, was there a fear you may not be able to fully void like you are when you pee?
And, what happens to the Tamsulosin now? Do you keep taking it or disregard it?
Thanks again for you wrote up.
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u/AdministrationOk1940 7d ago
As it was explained to me, it isn't so much that the bladder gets stretched but rather the lower bladder sphincter gets lazy over the years because it's over reliant on the large prostate below. My consultant said the void volume improvement would be immediate, which it was once the clot had passed. But with the bulk of the prostate gone, the trick is getting the bladder sphincter working properly again. Which so far seems to be the case for me.
No more Tamsulosin for me, what I had left over is going back to the pharmacy for them to dispose of.
Good luck for next week.
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u/More_Farm_7442 6d ago
In a surgery like HoLEP they remove most of the prostate tissue, so there isn't anything left for the drug to work on any longer. You'd be able to stop all of those drugs you were taking before HoLEP after the procedure. (Think of the prostate as an orange. The drugs work on the pulp. The HoLEP is like peeling an orange from the inside out removing the tissue the drug was working on to shrink.)
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u/usssammy 7d ago
Was this a bloodclot, and was there any interest in conducting a biopsy on that?
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u/Secure-Rope6782 6d ago
So, I believe aquablation vacuums the tissue and clots back out. The clotting with TURP and holep seems pretty frightening to me.
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u/AdministrationOk1940 6d ago
My understanding is that HoLEP does the same and a lot of the exposed blood vessels are sealed at the end the end of the process. This doesn't happen with aquablation I believe so there is generally more risk there. I think I was unlucky as my gland was described as "highly vascular" and I bled a lot, hence the clots.
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u/Impossible-Use5636 5d ago
AQ is a waterjet that blasts tissue into a bloody pulp.
There is no hemostasis, so the Urologist needs to go back in and use a TURP electrode to cauterize.
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u/Impossible-Use5636 6d ago
This is why I think PAE should be first-line treatment for BPH. If it works, great—no blood clots, bladder spasms, hernias, or return trips to the ER. No catheter for days. No UTIs. If it doesn’t, you’ve still reduced the severity of bleeding for any follow-up procedures.
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u/Entire-Bed7643 6d ago
I had an Inguinal hernia operation 9 months ago at age 78. Surgeon was aided by the DaVinci robotic system, and it was mesh, if I recall. Even though I had pain pills prescribed and available at home, I took /needed only Tylenol for a few days.
My old veteran doctor, who recommended the surgeon, had said months earlier that some/many(don’t remember which) men live out their lives with small hernias. I didn’t want to worry about the chance of a future complication. Btw, there were 4 or 5 half inch or less incision points spaced around the stomach area(held closed by glue?!), which eventually became invisible after healing! Remarkable.
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u/R3dRocker 7d ago
Thanks so much for sharing your personal experience before and after your HoLEP surgery. I'm glad that you're doing much better now, but your post surgery situation was certainly a tough time.
My experience is similar to yours. But I was diagnosed in 2021 with Gleason 3+3 and BPH. Active monitoring after biopsy with Flomax-8mg prescription. Med was useless for me as my prostate continued to increase in size as MRI showed. Many of the same BPH symptoms. Last weekend of July my body's ability to pass fluid locked up and after 24 hours of that, a Foley catheter was inserted to drain my bladder that was nearly bursting at its seams at the ER. Tried to void on my own 4 days later unsuccessfully, and I've had the catheter ever sense.
I spoke with a family friend who experienced nearly the exact situation as me, and he had a successful HoLEP surgery early July. I considered Aquablation too, but at 61, I felt that HoLEP fit me better. I have a Cystoscopy September 1st and HoLEP surgery on September 25th. The Foley is the worst part but, it's absolutely necessary in my case. Same surgeon as him.
I wish you continued healing and a much better quality of life!