From the Guidelines
It is normal to experience dysuria and nocturia 3 weeks after a Holmium Laser Enucleation of the Prostate (HoLEP) procedure, as these symptoms are part of the expected recovery process. These symptoms are typically transient and can be managed with adequate hydration, reduced fluid intake in the evening, and over-the-counter pain medications like acetaminophen 1. During the healing period, which typically takes 4-6 weeks for most patients, the bladder and urethra are still adjusting to the changes from surgery. To minimize discomfort, it is recommended to avoid caffeine, alcohol, and spicy foods which can irritate the bladder. However, if dysuria is severe or accompanied by fever, cloudy urine, or blood clots, it is essential to contact your urologist as these could indicate an infection or other complication requiring medical attention 1. Most patients see gradual improvement in these symptoms as healing progresses, with complete resolution typically occurring within 6-8 weeks post-procedure. The current evidence from the 2023 European Association of Urology guidelines on the management of non-neurogenic male lower urinary tract symptoms supports the safety and efficacy of HoLEP, with low rates of complications such as urethral stricture and bladder neck contracture 1. Overall, while dysuria and nocturia can be uncomfortable, they are generally a normal part of the recovery process after HoLEP, and most patients can expect to see significant improvement over time with proper management and follow-up care. Key points to consider include:
- Managing symptoms with hydration, pain medication, and lifestyle modifications
- Monitoring for signs of infection or other complications
- Following up with your urologist for post-procedure care and guidance
- Understanding that recovery times can vary, but most patients see improvement within 6-8 weeks.
From the Research
Postoperative Symptoms after HoLEP
- Dysuria (painful urination) and nocturia (nocturnal urination) can be experienced by patients after Holmium Laser Enucleation of the Prostate (HoLEP) due to various reasons, including the surgical procedure itself or underlying medical conditions 2.
- A study published in 2022 found that postoperative complications, including urinary retention and fever, can occur after HoLEP, but the overall rate of complications is relatively low, with less than 2% being high-grade complications 3.
- Nocturia is a common symptom in patients with benign prostatic hyperplasia, and HoLEP can help improve this condition by relieving lower urinary tract obstruction 4, 5, 6.
Nocturia and Nocturnal Polyuria
- Nocturnal polyuria (NP) is a major contributing factor to nocturia, characterized by overproduction of urine at night, and can be caused by various factors, including hormonal, sleep, and cardiovascular factors 5.
- A study published in 2014 found that HoLEP can improve NP by reducing the nocturnal polyuria index (NPI) and improving nocturia symptoms 4.
- Lifestyle modifications and pharmacotherapy, including antidiuretic treatment, can be used to manage nocturia and NP, but a multidisciplinary approach is necessary to effectively diagnose and manage these conditions 5, 6.
Dysuria
- Dysuria can be caused by various factors, including urinary tract infection, sexually transmitted infection, and bladder irritants, and a thorough history and physical examination, as well as urinalysis and urine culture, are necessary to diagnose and treat the underlying cause 2.
- In patients who have undergone HoLEP, dysuria can be a postoperative symptom, but it is essential to investigate other potential causes, including infection or non-infectious causes, to provide appropriate treatment 3, 2.