Preparing for Your HoLEP Surgery

To prepare you for your upcoming HoLEP (Holmium Laser Enucleation of the Prostate) surgery, please read and follow the instructions in this handout.

What should I expect before my surgery?

If you take a blood thinner, please let Dr. Hudson know well in advance of your surgery date. Blood thinners can cause increased bleeding after prostate surgery. Dr. Hudson will recommend when to safely stop and restart your blood thinner medicine before and after your surgery.

Dr. Hudson instructs most patients to stop taking their blood thinner medicine a week before their surgery and to restart their medicine a week after surgery. These stop and start times depend on your specific situation. Follow doctor’s orders.

Examples of blood thinner medicines include: Aspirin, Plavix (Clopidogel), Coumadin (Warfarin), Argatroban, Pradaxa (Dabigatran), Xarelto (Rivaroxaban), Eliquis (Apixaban), Edoxaban

Your Preadmission Testing appointment

Up to two weeks before your surgery day, you will have an appointment with Saint Francis Hospital’s Preadmission Testing Department (PAT). PAT staff prepare you for your upcoming surgery according to doctor’s orders. This may include blood tests, a urine test, chest x-ray, and/or an electrocardiogram (EKG). These tests check your general wellness before surgery. A staff member of the Anesthesia Department will speak with you about the anesthesia you receive during surgery.

You may receive general anesthesia (you are asleep throughout the surgery) or spinal anesthesia (a doctor places medicine into your spine that makes you numb from the waist down). Although you are awake with spinal anesthesia, you will be drowsy and very comfortable. The anesthesia staff will explain the pros and cons of each type of anesthesia.

Day of surgery

It is very important that you not eat or drink anything for at least 8 hours before your surgery. This includes chewing gum, hard candy, chewing tobacco or snuff. If you smoke or use an electronic cigarette, try not to smoke after midnight.

You will check into the admitting area where a nurse will prepare you for surgery. This includes getting you into a surgical gown and starting your IV, as well as any other orders your doctor has for you.

What happens during the surgery?

HoLEP surgery usually takes between 45 to 120 minutes, depending on the size of your prostate.
The anesthesia provider will give you a dose of antibiotic before surgery, after checking your allergies.
The laser separates the obstructing prostate tissue from its surrounding capsule and pushes large chunks of the separated tissue into the bladder.
The doctor removes the tissue from the bladder with an instrument placed through a telescope.
At the end of the procedure, the doctor places a catheter to drain the bladder.

What should I expect after surgery?

Patients will spend one night in the hospital after their surgery. This is due to some bleeding from the prostate area after the operation.

The urine is usually clear of blood after 24 hours.
It is quite common to see a small amount of blood in the urine for up to six weeks after surgery.
While this concerns some patients, it is very unusual for a patient to need a blood transfusion after laser surgery (1 to 2% of patients).Drink more fluids than normal the first 24 hours after surgery.
This helps the urine clear blood away more quickly.
At times, to clear the urine of blood, the doctor may flush fluids through the catheter and into the bladder. Outside of the discomfort of having a catheter, many men will not have pain after their laser surgery.
The catheter is usually removed the morning after surgery.
After the catheter removal, you may have some pain when you first urinate on your own. This tends to resolve fairly quickly.

There is medicine available to help with the pain if necessary.

After the catheter removal, you may urinate more often than normal. – This usually improves in a few days.

Some symptoms, especially how often you urinate, an urgent need to urinate, and getting up at night to urinate may not improve for several months. These symptoms are often due to bladder overactivity (which takes time to resolve after prostate surgery) rather than prostate blockage.

If you are unable to urinate or your bladder feels full after catheter removal, let your nurse know. Some patients are unable to pass urine right after surgery. This is not uncommon and may occur for a variety of reasons. If this should happen, the nurse will reinsert a catheter to allow the swelling to go down and the bladder to regain its function. Usually patients who require another catheter go home with the catheter in place, and return within a week for a second catheter removal, which is successful in almost all cases.

HoLEP surgery removes a large portion of prostate tissue, providing excellent relief of prostate blockage and less of a need for repeat prostate surgery. However, there may be some temporary loss of urinary control until your pelvic floor muscles strengthen and recover. For this reason Dr. Hudson encourages you to practice kegel exercises to strengthen the pelvic floor.

Patients who practice kegel exercises before and after surgery will have a lower risk of urine leakage (also called urinary incontinence). If this does occur, it normally resolves completely within a few months. For many patients, this resolves within a few days. Patients who have urinary incontinence may want to wear a pad inside their underwear to catch leakage. I recommend Men’s Guards. They come in a black bag and are usually next to the Depends at your local Walmart, Target, CVS, Grocery Store, Walgreens, etc.

The need to use a pad for the first six weeks occurs in about 30% of patients. The need to use a pad for longer than three months occurs in about 5 to 10% of patients. The need to use a pad for longer than a year occurs in about 2 to 3% of patients. It is helpful to restart kegel exercises as soon as possible after surgery. This helps improve control.

Symptoms of an overactive bladder may take up to three months to resolve. Flow of urine usually improves almost immediately.

What should I expect when I get home?

Most patients feel tired and not quite normal for a week or two after their surgery. This is not unusual. You just had major surgery.

For the first month after surgery, you may notice passing very small flecks of tissue in your urine as the prostate area continues to heal. This does not usually interfere with the urinary stream or cause discomfort.

What are some of the things I should watch for?

If you have an increased need to urinate, burning with urination, difficulty passing urine, or increased amounts of blood, call Dr. Hudson’s office.

About one out of five men may have bleeding for 10 to 14 days after getting home. This is due to scabs separating from the cavity of the prostate. Increase the amount of fluid you drink. This should help stop the bleeding within 24 hours. If drinking more fluids does not help with the bleeding, contact Dr. Hudson or your primary care doctor’s office. You may need a prescription for antibiotics.In the unlikely event of severe bleeding, if you pass clots, or you have sudden difficulty passing urine, call Dr. Hudson’s office immediately. It may be necessary to readmit you to the hospital.

Are there any other important points?

Sexual activity can resume as soon as you are comfortable, usually three to four weeks after surgery. If you have normal erections before surgery, removal of your prostate should not adversely affect your ability to have an erection.

After prostate surgery, it is very common to not be able to ejaculate any semen at the point of orgasm. This happens because it is much easier for the semen to travel back into the bladder than down and out through the penis. This is not an uncomfortable or harmful consequence of surgery, and most men say the experience of orgasm remains a pleasurable sensation. This is only an issue if you plan on fathering children in the future.

Lab results for tissue removed during surgery is usually available 7 to 14 days after surgery. Dr. Hudson will see you back in his office in two weeks to go over your tissue results and to see how you are progressing.

Most patients need one to two weeks to recover at home before returning to work. We recommend two weeks of rest before returning to your job, especially if your job is physical. Avoid lifting heavy objects during your recovery period. Do not drive until you feel fully recovered.