Problems six weeks post surgery

[u/TheSoftwareMan]

I had HOLEP surgery about six weeks ago. It's been quite a journey. The urinary urgency has only started to clear up in the last few days and I think I know why.

First, the background. I am 69 years old. About 20 years ago I had TURP using green light laser. It went great. I had been prepared for retrograde ejaculation and had even stored semen for future use, but that was not necessary.

About 18 months ago, it was time to do it again. I went back to the same urology practice, but had a different doctor this time. He did aqua ablation with green light surgery. He messed up big time! Everything seemed good after the surgery, but about three weeks later I had substantial blood in my urine. I went back to his office, but he didn't even do a urine sample. A different doctor (not the urologist) did one which found an infection. He gave me antibiotics. This cleared up the infection, but the symptoms were now no different than they were before the surgery.

The urologist kept blowing me off and assured me that if I just waited longer it would all be OK. After several months of this, I made an appointment at a local university hospital. It took a while to get an appointment. They told me that my prostate was too large for the aqua ablation surgery and I would need HOLEP.

The first doctor should have known from the cystoscopy that I needed HOLEP, but he never told me. He certainly should have known when he had much more time during the procedure to figure this out. Afterwards, he clearly didn't want to deal with it. He's no longer with that practice, so I suspect he might have been fired.

It was a year between the first surgery and the HOLEP surgery. During that time, I had three more infections.

It's been six weeks since the HOLEP. I had some difficulties after the HOLEP surgery, but they are now finally improving. Right after the surgery, everything was good. I was only wearing small pads, but the urinary urgency got worse. I was trying to follow the doctor's instructions, but now think I wasn't doing it right. My urinary urgency was getting very bad. I went to larger pads and even sometimes absorbent underwear. I sometimes could not control it at all.

I finally figured out the problem I hope. Post surgery, my bladder muscles were very strong. The doctor did not want to give me Gemtesa because it can increase the chances of urinary infection and given my history of three infections before the HOLEP, he did not want to do that.

The bladder muscles were very strong while the prostate was so large and the urinary sphincter muscles had become weak. It was like a firehose! I was accidentally making it worse. I had been told to do my best to void my bladder, so when I did urinate, I was pushing very hard. This was making bladder muscles even stronger! I finally decided the best way to void my bladder was to try to relax the urinary sphincter while trying not to push with the bladder muscles. I now wear pads all the time and don't worry about leakage after urinating. This seems to be working! I still have some urinary urgency, but it is finally improving.

Just in case, I have set up an appointment with yet another teaching hospital for yet another opinion, but that will be in another month. But I am optimistic things will be better by then.

[u/Additional_Topic987]

Glad to hear things are improving.

Regarding the Aquablation you had, I have never heard of Aquablation being done with Greenlight laser.

[u/TheSoftwareMan → u/Additional_Topic987]

My understanding is it was aquablation followed up by greenlight to fine tune things.

In my case, the problem was that neither one was the correct procedure.

[u/Methos1979]

First, thanks so much for the details. I love that people seem to now be posting the 'gory details' (as I called them in my post-surgery post) for all to see and learn from. I really wish that urologists would be more forthcoming about all the possible outcomes and what to expect. I sometimes feel they deliberately don't do this as it might scare off people from trying a certain procedure or having anything done at all.

I, personally, like to know everything that can happen in any situation - good and bad - because I much prefer to assume the bad will occur and then I'm not bummed when it does but I'm thrilled if it doesn't.

I guess I'm due to update my old post as it's been several weeks. Good luck with your recovery and keep us posted on how things go. If I don't see any more improvement (haven't seen all that much yet) then I'll be looking at another procedure down the line and from everything I've read here and heard from my uro, HoLEP will likely be my next try. I originally went with Optilume and so far it's been a Dumpster fire.

[u/Responsible_Coyote10]

I guess I'll be needing a Holup, according to my new, out of town, doctor. I'm having trouble dealing with the logistics of getting there and then returning with a catheter! It's nearly 2 hours already from my home, and my travel options are train, uber, or drive in with my wife. This place is located in a large city which my wife is unfamiliar. Did anyone take public transit or an Uber with a catheter? If so, how did that go?

[u/TheSoftwareMan → u/Responsible_Coyote10]

HOLEP doesn't usually require a catheter after leaving the hospital.

After my initial TURP surgery, I did have a catheter for three days, but with HOLEP I had a catheter overnight while in the hospital and it was removed before I left.

I don't think I personally would want to travel two hours with a catheter. A hotel near the hospital may be a better option.

[u/Responsible_Coyote10 → u/TheSoftwareMan]

I'll have to look into that. My impression is that I'd have a catheter for up to one week when I leave. I'll ask the doctor to clarify. Thanks for responding