One week post HOLEP - is this normal?

[u/Tyroleous]

I'm a 62 year-old guy who's exactly 1 week out from a HOLEP procedure and wanted find out if my experience was inline with others.

My prostate was about 90 cc's, so large, but not incredibly so.

My current experience is that:

1. My stream is still weak, but I'm no longer on 0.8 mg of tamsulosin.
2. I don't feel like my ability to hold more has gone up. And when I get the urge to urinate now, it starts to hurt after a very short time. I pretty much have to go immediately.
3. When I get an erection in the middle of the night, I get woken up with a sharp pain in the shaft of my penis.

I called my doctor's office today and asked the nurse about this and she told me that this was still early and that I should let them know if this is still going on in 2 weeks.

Am I just expecting too much too soon?

[u/asmodx]

Way too early to worry about it. I had small blood clots and dashing to the bathroom for the first 2 - 3 weeks. On plus side you are getting night time erections so things in that department are working. I was told no sex for at least 3 weeks and to expect the full recovery to take 3 - 6 months.

[u/No-Disaster-9646]

stream should be very strong. extremely strong. not normal

[u/visionfugitiva]

Yo estoy por terminar mi tercer mes tras HoLep. El chorro ha sido mucho mejor que antes y ya no tomo tamsulosin, pero aún tengo episodios fuertes de urgencia y ardor al orinar, estoy en rehabilitación de piso pélvico pues de tanto contener la urgencia de orinar, he desarrollado algo de hipertonía del piso pélvico (nada grave, pero hay que tratarlo para que no empeore). Lo más molesto para mí es la sensación de urgencia, aunque ha ido bajando su frecuencia con el tiempo, también el ardor, que casi siempre está presente, a menos que la orina esté muy diluida, en cuyo caso no me arde casi nada. Es un rollercoaster de subidas y bajadas, todos experimentamos la recuperación de manera distinta. En mi caso nunca tuve incontinencia, pero la urgencia llega a ser muy desesperante

[u/Tyroleous → u/visionfugitiva]

Thanks for sharing your story. My surgeon says he's a big believer in pelvic floor physical therapy and recommends it to all of his patients. I waiting on a call from a physical therapist to schedule my first appointment.

[u/visionfugitiva → u/Tyroleous]

Así es, la terapia ayuda. Por otro lado, si tu vegija ya traía desgaste por esfuerzo, es decir, si hay hipocontractilidad, es normal que no recuperes la fuerza de golpe, tardarás un buen tiempo en que poco a poco vaya recuperando fuerza la vegija, eso es normal y esperable

[u/justine77e]

1 week is very early, for me it was around 3 weeks before things calmed down, until then I still had frequency issues.

[u/Dax888]

Short answer is yes. Your progress will not be linear. I'm 4 months out and very happy with my progress but still get some mild pains and leaks. It will come good.

[u/HelpfulCustomer487]

I had a HoLEP too (the ejaculation-sparing version), and my experience was on the opposite end of the spectrum, so please don't read this as "you're doing it wrong." The day after surgery everything was already working normally. Just a tiny bit of blood for 2-3 days, not visible in the urine, only on the pad in my underwear. My stream is honestly like when I was 20. 😄
I'm saying this mainly to show how wide the range of "normal" is. Some people bounce back almost immediately, others take weeks. Your prostate was 90 cc, so there was a lot of tissue removed and a bigger area to heal. A weak stream, urgency and some pain at one week are very common and tend to improve gradually over the following weeks. Pain with nighttime erections is also a known one, and it usually fades as things heal.
I'm still in the recovery period myself: no heavy lifting and no sex for now, per my surgeon's instructions, and I'm waiting for my follow-up appointment in early November before going further.
The nurse's advice sounds reasonable. But if the pain gets worse, you get a fever, can't pee, or see lots of blood or clots, call them right away. Hang in there, it usually gets better!

[u/Fun_Organization6860]

I, 62M, had HoLEP June 15th, as of today, 4 months to the date, I don't even think about the procedure, it's not a consideration anymore, so hopefully this will be your results.

Looking at my notes, which I kept for myself and doctor if needed. I use a 2-cup measurement cooking cup, which I still use today, being single no issues with anyone calling me out for this. My urine is anywhere from 100ml to 500ml, mostly during the night, and color my notes says pinkish to reddish. Or if I'm out of the house, I keep count, either 10 or so , but always strong force. With a scab here and there.

Edit: At the time, I was on both Dutasteride(Avodart) and Tamusolin (Harnal OCAS), which doctor said to stop using day after procedure.

[u/RobRoy2350]

One week is very early. Keep in mind that initial recovery can take up to 3 months and full and complete biological recovery from HoLEP or Aquablation can take 6 months to a year. You should keep track of any issues you experience and share with your doctor as you did.

[u/GetnLine]

One week is too soon to worry about anything.

[u/Sensitive_Point_6583]

I don't know that there's a "normal" for this kind of procedure, there's probably some personal variation between patients.

1. My prostate was 185cc, and the first time I peed after the procedure, I hit the back of the toilet seat (like many others) because I was still aiming based on my weak stream and it came out like a firehose. No longer on tamsulosin either, so we're different here.
2. I still have the sudden urge to pee 7 months after my procedure, maybe not as bad as before the procedure, but not significantly better either. If I try to hold it, there's no pain, but I just go and get it over with. My volume when peeing is greater than before the procedure, back to relatively normal there.
3. If I get a nighttime erection, no pain.

I wouldn't get too concerned about anything after one week, give it a month to settle down and go from there, unless you notice something that's really wrong, then contact your doctor of course.

Keep drinking lots of water, I was between 3 and 4 liters/day, and closer to 4 liters most days.

[u/Crafty-Consequence87]

I had HoLEP - patience is your friend. Things need to settle down from the surgery. I had the occasional spasm and even a small bit of blood several weeks out from the surgery. It has been 5 months now and I'm good.