What to expect after HoLEP

In hospital

Catheter. A urinary catheter is in place when you wake up. It has a channel that continuously flushes the bladder with saline for the first several hours to clear any small amounts of blood and clot while the operative site seals.⁹
Eating and drinking. Most men can eat and drink soon after the anaesthetic wears off.
Pain. There are no external cuts and pain is usually mild. Paracetamol is typically sufficient; an anti-inflammatory may be added. Discomfort from the catheter itself tends to be the most common complaint and settles once it is removed.
Length of stay. One to three nights is typical.^{4, 9} The catheter is usually removed in the morning once the urine is clear. Discharge home follows once you are passing urine satisfactorily, your temperature is normal, and any pain is controlled with simple medication.

The first two weeks

Blood in the urine. A pink tinge, or occasional small clots, is common in the first two weeks as the inside of the prostate heals. This may come and go, and can recur briefly between weeks one and four as a healing scab separates. Drink extra fluid and rest when it happens; it usually settles within 24 hours.
Burning and stinging on passing urine. Common for the first two to three weeks and does not usually mean an infection. Urinary alkalinisers (sachets available over the counter) can help.
Urgency and frequency. The bladder has been irritated by the catheter and the operative site, and these symptoms are often temporarily worse in the first few weeks before they start to improve.
Bowels. Constipation puts strain on the prostate bed and can trigger bleeding. Keep well hydrated, eat fruit, vegetables and fibre, and use a mild laxative if needed.
Pelvic-floor exercises. If there is any urine leakage on cough or exertion, starting gentle pelvic-floor exercises early tends to shorten the period of transient leakage.^{13, 14}
Activity. Walking is encouraged from the day you go home. Avoid heavy lifting (more than 3-5 kg), cycling, digging in the garden and straining for the first two weeks.
Driving. Short local trips are usually fine from about 1-2 weeks, provided you feel well and are not taking strong painkillers. Avoid long drives for four weeks.
Work. Many men are back to a desk job within 1-2 weeks. A physical job may need 3-4 weeks.
Sexual activity. Avoid intercourse for two weeks, then resume at your own pace.

Weeks two to six

Urinary flow continues to improve.
Blood in the urine should gradually stop.
Frequency and urgency usually settle over the first three months; most men notice a clear improvement by six weeks.⁹
Strenuous exercise, heavy lifting and cycling can usually be resumed from around four weeks.

Three to six months

Most of the urinary improvement will be apparent by three months. Some men notice further gains in flow and emptying out to six months.
Nocturia (waking overnight to pass urine) often takes the longest to settle, particularly if it has been a long-standing problem.
Medications taken before the operation for BPH are usually stopped once the operation has taken effect.

Follow-up

A post-operative review is usually arranged about six weeks after surgery. The visit typically includes:

A urinary flow rate and bladder scan to document improvement.
Review of the pathology report from the prostate tissue that was removed.
A symptom score (for example the International Prostate Symptom Score) to compare against pre-operative results.
A discussion of any medications that can now be stopped.

When to seek medical attention

Call the practice, the urology ward, or attend the nearest emergency department out of hours for any of the following:

Heavy or bright-red bleeding that is getting worse rather than lighter.
Passing large clots or being unable to pass urine at all.
A fever above 38 degrees Celsius, shaking chills, or cloudy and offensive urine.
Severe lower abdominal pain not controlled by simple painkillers.
New leg swelling, calf pain, chest pain or breathlessness (to rule out a clot).