Holmium Laser Enucleation of the Prostate (HoLEP): What to Expect at Home

Holmium laser enucleation of the prostate (HoLEP) is surgery to reduce or remove prostate tissue. It is done when an overgrown prostate gland is pressing on the urethra and causing problems with the urine stream.

After the surgery, you will have a urinary catheter for a short time. It is a flexible plastic tube used to drain urine from your bladder when you can't urinate on your own. If it is still in place when you go home, your doctor will give you instructions on how to care for it.

For several days after surgery, you may feel burning when you urinate. Your urine may be pink for 1 to 3 weeks after surgery. You also may have bladder cramps, or spasms. Your doctor may give you medicine to help control the spasms.

You may still feel like you need to urinate often in the weeks after your surgery. It can take up to a few months for this to get better. After you have healed, you may have less trouble urinating. You may have better control over starting and stopping your urine stream. And you may feel like you get more relief when you urinate.

After HoLEP, most people can resume their daily activities in 1 to 2 weeks. But you may need to avoid heavy lifting and strenuous activities that might put extra pressure on your bladder for a few weeks.

Most people still can have erections after surgery if they were able to have them before surgery. But they may not ejaculate when they have an orgasm. Semen may go into the bladder instead of out through the penis. This is called retrograde ejaculation. It does not hurt and is not harmful to your health, but it can affect fertility. Talk with your doctor to learn more.

For the first 24 hours after surgery:

• Do not drive or operate heavy or dangerous machinery.
• Do not make any important decisions or sign any important papers.
• Do not drink alcohol.

• Rest when you feel tired.
• Be active. For many people, walking is a good choice.
• Allow your body to heal. Don't move quickly or lift anything heavy until you are feeling better.
• You may shower and take baths when your doctor says it is okay.
• Don’t smoke, vape, or se other tobacco or nicotine products. These things slow healing and recovery. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good.
• Many people are able to return to work within 1 to 2 weeks after surgery.
• Do not put anything in your rectum, such as an enema or suppository, for 4 to 6 weeks after the surgery.
• Ask your doctor when you can drive again.
• Ask your doctor when it is okay for you to have sex.

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• If your bowel movements are not regular right after surgery, try to avoid constipation and straining. Drink plenty of water. Your doctor may suggest fiber, a stool softener, or a mild laxative.

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you take aspirin or some other blood thinner, be sure to talk to your doctor. The doctor will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
• Be safe with medicines. Read and follow all instructions on the label. Contact your doctor or pharmacist if you have questions about the instructions.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • Store your prescription pain medicines where no one else can get to them. When you are done using them, dispose of them quickly and safely. Your local pharmacy or hospital may have a drop-off site.
• Take your antibiotics as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have chest pain, are short of breath, or cough up blood.

Contact your doctor now or seek immediate medical care if:

• You have pain that does not get better after you take pain medicine.
• You have new or more blood clots in your urine. (It is normal for the urine to be pink for a few days.)
• You can't pass urine.
• You have symptoms of a urinary tract infection. These may include:
  • Pain or burning when you urinate.
  • A frequent need to urinate without being able to pass much urine.
  • Pain in the flank, which is just below the rib cage and above the waist on either side of the back.
  • Blood in your urine.
  • A fever.
• You are sick to your stomach or can't keep down fluids.
• You have symptoms of a blood clot in your leg (called a deep vein thrombosis), such as:
  • Pain in the calf, back of the knee, thigh, or groin.
  • Swelling in the leg or groin.
  • A color change on the leg or groin. The skin may be reddish or purplish.

Watch closely for changes in your health, and be sure to contact your doctor if you have problems.