HoLEP Surgery - Patient Guide

Plain-English guidance on enlarged prostate, HoLEP and treatment in Madrid. Patient education from Dr Fernando Gómez Sancha and ICUA. Not medical advice.

[HoLEP Surgery - Patient Guide @holepsurgery]

An enlarged prostate can shrink your world: broken sleep, weak flow, toilets mapped before every journey.
Clear answers about treatment trade-offs, HoLEP and travelling to Madrid. No hype. No diagnosis.
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[HoLEP Surgery - Patient Guide @holepsurgery]

HoLEP is not only a “big prostate” operation. The same idea works for a small3 gland: remove the adenoma from the inside, in one piece.

Size is not the reason to delay.

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[HoLEP Surgery - Patient Guide @holepsurgery]

Some men only look at surgery once they are already on a catheter.

By then the bladder has been working against a blockage for a long time. You do not have to wait for that moment.

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[HoLEP Surgery - Patient Guide @holepsurgery]

A lot of men put off the conversation for years. Not because the nights are fine. Because talking about urine still feels awkward.

It is a plumbing problem, not a character test.

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[HoLEP Surgery - Patient Guide @holepsurgery]

Pills can quiet the stream. They do not shrink the gland back to twenty.

If nights are still bad after a fair trial, the next question is not a stronger tablet. It is whether the blockage is still there.

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[HoLEP Surgery - Patient Guide @holepsurgery]

"It's just age" is how a lot of men lose ten years of sleep.

Waking three times a night is common. You do not have to live with it.

A lot of men wait because surgery still looks like their father's operation. It does not.

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[HoLEP Surgery - Patient Guide @holepsurgery]

BPH is not rare. It affects more than half of men over 50.

Most start with pills. Many do well for years. The ones this account is for are the men for whom pills are no longer enough, or never were.

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[HoLEP Surgery - Patient Guide @holepsurgery]

After 50, the prostate often keeps growing. Not in every man, not at the same speed.

Some stay a walnut. Some become an orange. A modest gland can block more than a huge one.

What matters is emptying, sleep and quality of life.

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[HoLEP Surgery - Patient Guide @holepsurgery]

The prostate is a walnut-sized gland under the bladder. It wraps the urethra, the tube you pee through.

When it grows, it squeezes that tube. That is why the stream gets weak, why you go often, why you wake at night.

The growth is not cancer. It is BPH.

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[HoLEP Surgery - Patient Guide @holepsurgery]

Prostate surgery is not your father's operation. No open wound. One night. Catheter for less than 24 hours; not weeks. The fear is usually of a surgery that no longer exists.

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[HoLEP Surgery - Patient Guide @holepsurgery]

The pills on the nightstand buy you time. They do not shrink the prostate. If you still wake twice, still strain, still plan your day around toilets, the medicine is doing what it can. The next question is whether that is enough.

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[HoLEP Surgery - Patient Guide @holepsurgery]

HoLEP does not take away erection or orgasm.

The usual change is retrograde ejaculation: semen goes into the bladder. Harmless. Worth knowing if you still want fertility.

Many men say sex is better once they can sleep and empty their bladders properly

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[HoLEP Surgery - Patient Guide @holepsurgery]

Rez��m, UroLift and Prostate Arteries Embolisation (PAE) can fail. That does not mean you are stuck.

HoLEP can still take the whole obstructing adenoma out, even after a failed “minimally invasive” procedure.

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[HoLEP Surgery - Patient Guide @holepsurgery]

If you fly in for HoLEP, plan to stay 5–7 days in Madrid.

Arrive the day before. 1 night in the hospital. A few days nearby. Then you fly home.

Follow-up is by video conference, from your home.

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[HoLEP Surgery - Patient Guide @holepsurgery]

HoLEP is for the man whose pills are not enough.

Very large prostate. On blood thinners. TURP that came back. Symptoms after pelvic radiation.

If you were told you are “too big” or “too complex”, that is usually the case we operate.

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[HoLEP Surgery - Patient Guide @holepsurgery]

HoLEP takes the obstructing prostate out in one piece, like peeling an orange. It does not chip it or burn it away.

Any size. Catheter usually out at 24 hours. Home in 1–2 nights.

Not TURP. Not GreenLight. Not Rezum.

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[HoLEP Surgery - Patient Guide @holepsurgery]

For men trying to understand prostate surgery.

What HoLEP is. Who it is for. What week one feels like. How it compares to TURP, Rezum or GreenLight.

Edited by Fernando Gómez Sancha, urologist, Madrid.

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