Recovery after HoLEP: week by week

The timings here are lifted from trust leaflets written for their own patients, so they differ a little from one hospital to the next. They describe what is common, not what is guaranteed, and your surgeon's or nurse's advice overrides them.

HoLEP recovery differs from TURP and from minimally invasive options in a few ways: bleeding can flare after a settled period, urgency and leakage are common early, and ejaculation changes are expected. The operation itself is described in our guide.

Durations come from NHS trust leaflets and differ between hospitals.

A catheter is left in at the end of the operation, often with fluid running through to clear blood. Many men go home the same day with the catheter still in, and one leaflet says some stay overnight. Expect blood-stained urine that varies from pink to darker red, and a strong urge to pass urine, which is the catheter and the bladder reacting.

Drink plenty of fluids; trusts suggest two to three litres a day for the first days. Walk around, keep the catheter clean, and keep the bag below the bladder. The catheter comes out between the next day and about a week later depending on the hospital and how you are, and your discharge information should say who takes it out.

Light bleeding for at least two weeks is described, and some men have a heavier spell around two to four weeks as the healing surface sheds. Drinking more usually settles it. Go to A&E or ring your team if bleeding is heavy, clots block the flow, or it continues beyond a day or two.

A stronger than usual urge to pass urine is common at first, and stress leakage when coughing or lifting is expected in the early weeks. A trust leaflet recommends pelvic floor exercises with an app-based routine, giving eight repetitions three times a day. Constipation and straining can start bleeding again, so eat fibre and avoid straining.

Driving advice differs. Leaflets range from not driving for about two weeks to waiting until you are confident of an emergency stop, and they all start with no driving for the first 24 hours after the anaesthetic. DVLA guidance says anyone unable to control a vehicle safely must not drive, and that ignoring medical advice may affect insurance cover, so check your insurer too.

Work after one to two weeks is common for lighter jobs, with a trust saying a week should normally be enough depending on workload and another saying most take two weeks. Avoid heavy lifting and strenuous activity for two to four weeks. Sex can resume when the urine is clear and you feel comfortable, which two trusts put at around three to four weeks, and blood-stained semen can occur for weeks.

Most men find urinary frequency and urgency calm over the first few months. One trust says overactive-bladder-type symptoms usually get better within about six months. Ejaculation is expected to be retrograde, meaning semen passes back into the bladder, and this is permanent in most men.

A review is described at about three months, where flow, symptoms and the laboratory result on the removed tissue are discussed. Tell your team if symptoms are not improving, if leakage is persisting, or if you have trouble passing urine.

Go to A&E or call 999 for heavy bleeding with clots you cannot pass, severe pain, faintness, chest pain, breathlessness or a swollen painful calf. Ring your hospital ward or call NHS 111 for fever, burning that worsens, a blocked or leaking catheter, or being unable to pass urine after removal.

Contact your GP for increasing frequency, burning or difficulty urinating after the first few weeks, which can mean infection or a narrowing.