Dr. Brandon Childs, MD — Granger Medical Clinic, West Jordan, Utah
These instructions are your reference guide for recovery after your prostate procedure. Bookmark this page — you can return to it any time from your phone or computer. If something doesn't seem right or you have a question not answered here, call the office.
For most patients, Dr. Childs removes the catheter before discharge and sends you home the same day. You will be asked to urinate before leaving so the team can confirm you are voiding adequately. Your first urination after surgery may be uncomfortable, slightly bloody, or urgent — this is completely normal.
You will need someone to drive you home. Do not drive yourself. Even if you feel fine, the residual effects of anesthesia make driving unsafe for at least 24 hours.
Sedentary / desk work: Most patients return in 3–5 days, working from home initially.
Light physical work: Typically after 2 weeks.
Heavy physical / manual labor or lifting >10 lbs: After 2 weeks, then gradually reintroduce as tolerated.
Cycling / straddle activities: Resume after 2 weeks, starting gently and increasing as comfortable.
Urgency incontinence happens when the bladder sends a sudden, strong signal to void — and you can't always make it to the bathroom in time. This is very common after HoLEP and is not caused by a weak sphincter.
The reason it happens: for months or years before surgery, your bladder was working against a prostate obstruction. Under that chronic pressure, it adapted — becoming hyperreactive and prone to sudden contractions. Think of a clenched fist that has been held tight for years. Even after the obstacle is removed, the bladder takes time to "unclench" and relearn that it doesn't need to squeeze so urgently.
This type of leakage typically improves significantly within the first 4–8 weeks as the bladder recalibrates. The anticholinergic medication prescribed at discharge specifically helps with this by calming bladder contractions during the adjustment period.
What helps most: The anticholinergic medication if prescribed, reducing caffeine and alcohol, staying well-hydrated (counterintuitively, dehydration concentrates urine and worsens urgency), and pelvic floor exercises.
Stress incontinence is leakage triggered by physical activity — coughing, sneezing, laughing, standing up, walking briskly, or lifting. It happens when the external sphincter muscle is temporarily weakened and cannot maintain closure against sudden increases in abdominal pressure.
During HoLEP, the external sphincter is carefully preserved — it is not cut or removed. However, the surgery takes place very close to the sphincter, and some temporary weakness or fatigue is expected as the area heals. Dr. Childs uses the early apical release technique specifically to minimize disruption to the sphincter during surgery.
The good news: the sphincter is a muscle, and like any muscle it can be strengthened. This is exactly what Kegel exercises target. Most patients see meaningful improvement within 2–4 weeks of consistent daily Kegels, and the majority regain full control well within the first 3 months.
What helps most: Consistent pelvic floor exercises (Kegels) — this is the single most effective treatment. See the Pelvic Floor Exercises section and the Michelle Kenway YouTube video for guided technique.
Most patients recover urinary control quickly — but recovery timelines vary, and that variation is real and normal. Two factors most commonly associated with a longer recovery are age and prostate size.
Age: Older men tend to have less baseline sphincter muscle reserve, slower nerve recovery, and more pre-existing changes in bladder function from years of obstruction. A 75-year-old patient may take longer to regain the same control as a 60-year-old — not because anything went wrong, but because physiology differs. This does not mean full recovery is less likely — it means the timeline may be longer and patience more important.
Larger prostate size: Larger glands require more extensive enucleation across a wider surgical field. With a very large prostate, the sphincter complex is in proximity to the surgical dissection for a longer period, and some additional temporary disruption is possible. Patients with very large prostates may experience more pronounced early leakage that takes a few weeks longer to resolve. The end result — in terms of urinary control — is generally the same.
Pre-existing urgency: If you had significant urgency and frequency symptoms before surgery, your bladder has had longer to develop its overreactive habits. These habits take more time to undo even after the obstruction is gone. Anticholinergic medication and time are the most helpful tools here.
If you know you fall into any of these categories, set realistic expectations: improvement may be gradual rather than sudden, but the trajectory is almost always in the right direction.
If urgency and urgency leakage persist beyond the first few weeks, bladder retraining is the most effective behavioral treatment available. Medication helps, but it does not retrain the bladder — it only suppresses symptoms while the real work happens through habit and practice.
The concept: your bladder has been trained over years to signal urgency too early and too intensely. Bladder retraining teaches it to wait longer between voids and to tolerate a fuller bladder without panicking. This is done gradually and intentionally.
How to do it:
1. Keep a voiding diary for 3 days. Write down every time you urinate and how urgently you felt you needed to go. This gives you a baseline and helps identify patterns.
2. Set a starting interval. If you're voiding every 30–45 minutes, set a goal of waiting at least that long before going — don't go "just in case." Use a timer if helpful.
3. When urgency hits — pause, don't rush. The worst thing you can do is sprint to the bathroom the moment you feel the urge. This reinforces the urgency signal. Instead: stop moving, sit or stand still, take slow deep breaths, and perform 3–5 quick pelvic floor contractions (Kegels). The urgency will often pass or subside enough that you can walk — not run — to the bathroom calmly.
4. Gradually extend the interval. Every few days, try to add 10–15 minutes to your voiding interval. The goal over several weeks is to work up to voiding every 2.5–3.5 hours during the day without urgency or leakage.
This process takes patience and consistency — most patients who commit to it see meaningful improvement within 4–6 weeks. If urgency remains a significant problem beyond 6–8 weeks, bring it up at your follow-up visit.
If you were prescribed an anticholinergic medication at discharge (such as oxybutynin or solifenacin) and it is helping with urgency, continue it as directed. These medications calm overactive bladder contractions and are a helpful bridge while the bladder retrains itself.
However, anticholinergics are not the only option — and they don't work optimally for everyone. If urgency persists and you are not getting enough relief from your current medication, a different class of medication called a beta-3 adrenergic agonist (mirabegron / Myrbetriq) may work better for you.
Beta-3 agonists work through a completely different mechanism — instead of blocking nerve signals, they relax the bladder muscle directly during the filling phase, allowing it to hold more urine without triggering urgency. They are generally well tolerated and do not carry the dry-mouth, constipation, or cognitive side effects that some patients experience with anticholinergics. Some patients respond much better to one class than the other, and both can also be combined.
If you feel your current medication isn't providing enough relief, do not simply stop it or wait until your next appointment — call the office. Dr. Childs can adjust your prescription quickly.
Most men have never had to shop for incontinence products before and don't know where to start. Below are the most practical options, available at most pharmacies or shipped to your door via Amazon. Use these without embarrassment — they are a standard, practical tool during recovery, not a permanent fixture.
For most patients, Kegel exercises done consistently at home produce good results. But for some patients, working with a pelvic floor physical therapist produces significantly faster and more complete recovery — particularly for those with persistent urgency or stress leakage beyond 6–8 weeks.
A PFPT can confirm you are isolating the correct muscles, identify any muscle tightness or guarding that may be slowing recovery, and build a structured progressive program beyond what self-directed exercises achieve. PFPT addresses both weak muscles (stress leakage) and overactive, too-tight muscles (urgency), so it is valuable for both types.
Ask Dr. Childs about a referral if leakage or urgency is significantly affecting your quality of life by 6–8 weeks. PFPT is covered by most insurance plans with a referral and typically involves weekly sessions for 4–8 weeks.
One of the most important things to know: your BPH medications are stopped immediately after surgery. Because HoLEP removes the obstructing prostate tissue entirely, there is no longer a medical reason to take alpha-blockers (Flomax/tamsulosin, Rapaflo, Cardura) or 5-alpha reductase inhibitors (finasteride, dutasteride/Avodart). Do not restart them unless Dr. Childs specifically instructs you to.
| Medication / Type | Instruction | Notes |
|---|---|---|
| Pyridium (phenazopyridine) Urinary pain reliever — if prescribed |
Take as Directed — 3 Days | Helps significantly with the burning sensation during urination in the first few days. Turns urine bright orange — this is normal and harmless. Do not be alarmed by the color change. |
| Anticholinergic / Bladder Medication (e.g. oxybutynin, solifenacin, mirabegron) — if prescribed |
Take as Needed | Helps reduce urgency, frequency, and bladder spasms after surgery. Also helpful if you experience discomfort with a catheter in place — the bladder can spasm around the catheter balloon, causing urgency or leakage. This medication helps calm those spasms. Take as needed for comfort. |
| Anti-inflammatory (NSAID) (e.g. meloxicam, naproxen, celecoxib) — if prescribed |
Take as Directed — if prescribed | If Dr. Childs prescribed an NSAID for you specifically, take it as directed. Do not self-add over-the-counter NSAIDs (ibuprofen/Advil, naproxen/Aleve) unless prescribed — these can increase bleeding risk. Use Tylenol (acetaminophen) for additional pain relief if needed. |
| Flomax / Tamsulosin Alpha-blocker for BPH |
STOP — Do Not Restart | No longer needed. The obstruction has been removed. |
| Finasteride / Dutasteride (Avodart) 5-alpha reductase inhibitor |
STOP — Do Not Restart | No tissue remaining to shrink. Permanently discontinued. |
| Stool Softener (e.g. Colace / docusate) OTC — recommended |
Recommended for 2 weeks | Straining to have a bowel movement can trigger bleeding. Available over the counter. Take daily for 2 weeks. |
| Antibiotics If prescribed |
Complete the Full Course | Take every dose, even if feeling well. Do not stop early. |
| Blood Thinners (Warfarin, Eliquis, Xarelto, aspirin) If previously prescribed |
Ask Dr. Childs | Follow the specific guidance given at your pre-op visit. Patients on blood thinners may notice pink or blood-tinged urine for a longer period after surgery — this is expected. Do not restart or stop without instruction. |
| All Other Regular Medications Heart, blood pressure, diabetes, etc. |
Continue as Normal | Take all other regular medications as prescribed unless specifically told otherwise. |
Drink 8–10 glasses (64–80 oz) of water per day for the first 2–3 weeks. This is the single most effective thing you can do to reduce bleeding, clear the bladder, and prevent infection.
If your urine turns bright red or you pass clots, increase water intake immediately. In most cases, increased hydration alone will clear the bleeding within a few hours.
You may feel like you are drinking "too much" — you are probably not. Adequate hydration is critical during recovery.
There are no specific dietary restrictions after HoLEP. Eat normally. However, avoid constipation — straining to have a bowel movement significantly increases pressure in the pelvis and can trigger bleeding. Eat fiber-rich foods (fruits, vegetables, whole grains), drink plenty of water, and take a stool softener (Colace / docusate) daily for at least 2 weeks. If you are constipated, contact the office before using an enema or suppository.
Dr. Childs's standard approach is to remove the catheter before you leave on the day of surgery and confirm you can void adequately before discharge. This is one of the things that sets his practice apart — most HoLEP programs leave catheters in place for 1–2 days as routine. For most patients at Riverton Hospital or Holy Cross, the catheter comes out the same day.
Occasionally, a patient cannot void adequately on the day of surgery. The most common reasons are a small blood clot temporarily blocking the urethra or post-operative inflammation — both of which resolve on their own within a few days. In these cases, the catheter is replaced temporarily for comfort and safety and removed at a follow-up visit or when voiding has normalized.
This is not a complication — it is an expected scenario for a small number of patients, and it resolves quickly in the vast majority of cases.
For patients traveling more than an hour or two to get home, Dr. Childs may occasionally choose to leave the catheter in place overnight. This is done purely for your comfort — a catheter eliminates the urgency and frequent bathroom stops that can make a long drive unpleasant in the first day of recovery. The catheter would then be removed at a follow-up visit.
When HoLEP is performed at the outpatient surgery center rather than the hospital, you will typically go home with the catheter in place. This allows you to leave sooner and get home comfortably, rather than waiting in the facility for a voiding trial. In this scenario, you will remove the catheter yourself at home — Dr. Childs's team will give you specific instructions before discharge on exactly how to do this safely.
If you have a catheter in place, you may notice a sudden urge to urinate even though the catheter is draining your bladder — and sometimes urine may leak around the outside of the catheter. This is normal and is caused by a bladder spasm.
The bladder does not always tolerate having a catheter balloon sitting inside it. In response, it may squeeze tightly and try to expel it — causing a sensation of urgency, pressure, cramping, or leakage around the catheter. This is the same mechanism as an overactive bladder.
If bladder spasms are uncomfortable, the anticholinergic medication (if prescribed) can help calm the bladder and reduce these episodes significantly. Take it as directed for comfort. Staying well-hydrated also helps.
Keep the area clean: Gently clean around the catheter insertion site (meatus) with mild soap and water once daily. Pat dry. Do not pull or tug on the catheter.
Secure the catheter: Use the leg strap or tape provided to secure the catheter to your thigh. This prevents accidental pulling and reduces irritation.
Empty the drainage bag when it is about half full, or before it gets heavy. Always wash your hands before and after.
Keep the bag below bladder level at all times — never lift the bag above your waist, as this can allow urine to flow back into the bladder.
Stay hydrated — continue drinking 8–10 glasses of water per day. If the catheter stops draining despite feeling full, or if you have severe pain around it, call the office immediately.
Kegel exercises can be performed gently while the catheter is in place if comfortable.
Pelvic floor exercises (Kegels) strengthen the urinary sphincter muscles and significantly reduce the duration and severity of any temporary leakage after HoLEP. Most patients who do them consistently notice a meaningful improvement within 2–4 weeks. You may begin Kegels while the catheter is still in place if comfortable, and continue after removal.
Search "Prostatectomy Kegel Exercises for Men Michelle Kenway" on YouTube, or click the button above. Her step-by-step video is clear, clinically guided, and specifically designed for men recovering from prostate surgery.
Find the right muscles: Imagine you are trying to stop the flow of urine mid-stream, or trying to prevent passing gas. The muscles you tighten are your pelvic floor muscles. Use this as a reference only — do not make a habit of stopping urine mid-stream.
The technique:
1. Tighten the pelvic floor muscles and hold for 3–5 seconds.
2. Relax completely for 3–5 seconds — the relaxation is just as important as the squeeze.
3. Repeat 10–15 times. This is one set.
How often: 3 sets per day — morning, afternoon, and evening. You can do them lying down, sitting, or standing. Nobody can tell you are doing them.
Common mistakes: Do not hold your breath, tighten your buttocks, or bear down. Only the pelvic floor muscles should be engaged. If you are not sure you are doing them correctly, the Michelle Kenway YouTube video above will guide you clearly.
Progress: As the muscles strengthen over 4–6 weeks, gradually increase the hold to 10 seconds. Consistency matters more than intensity. Most patients see meaningful improvement within 2–4 weeks of daily practice.
Sexual activity may be resumed after 1 week. Orgasm causes pelvic muscle contractions that can temporarily increase bleeding in the early healing period, so allowing at least one week before resuming is recommended. Most patients feel ready around this timeframe and can resume gradually as comfort allows.
Most men notice no change in erectile function after HoLEP. If you have any concerns about erectile function during recovery, bring them up at your follow-up visit.
Retrograde ejaculation — semen traveling backward into the bladder rather than being expelled normally — is expected and permanent after HoLEP. This is a consequence of removing the inner prostate tissue that contains the muscle that normally closes during ejaculation. It is not painful, not harmful, and does not affect the sensation of orgasm. Your urine may appear slightly cloudy after orgasm — this is the semen that entered the bladder and is completely harmless.
Do not drive on the day of surgery under any circumstances — anesthesia impairs reaction time and judgment even when you feel fine.
After surgery: You may resume driving once you feel fully alert, comfortable, and capable of reacting quickly in an emergency. For most patients this is within a few days. If you feel sharp, pain-free, and are only using Tylenol if anything at all, driving is generally fine.
If you are unsure whether it is safe to drive, wait another day. When in doubt, ask someone to drive you.
Most patients notice the burning with urination improving steadily over the first 1–2 weeks. However, a small number of patients experience a prolonged burning or discomfort that continues for weeks or even months after surgery. This is uncommon — but it is real, and it is not your imagination.
The first and most important thing to know: this is almost never an infection. When patients with persistent dysuria come into the office for a urine culture, it is negative the vast majority of the time. Antibiotics will not help if there is no bacteria present, and unnecessary antibiotic courses can cause their own problems.
The exact cause in any individual patient is not always clear, but there are several mechanisms that likely play a role:
Healing inflammation: The laser creates a large raw surface inside the prostatic fossa that heals over weeks. As the tissue regenerates, some patients develop a prolonged inflammatory response — not an infection, but a chemical irritation. This is why a short course of anti-inflammatory medications (NSAIDs) helps many patients but not all.
Nerve sensitization: After pelvic surgery, the nerves in the area can become hypersensitive — continuing to signal pain or irritation even after the tissue itself has healed. This is similar to what happens in chronic pelvic pain conditions and explains why some patients feel burning that doesn't match any visible problem on examination.
Pelvic floor tension: Some patients unconsciously tighten their pelvic floor muscles in response to post-operative discomfort — often without realizing it. This protective guarding can become self-perpetuating, creating its own cycle of tension and irritation long after the original trigger has resolved.
Urine culture first: A urine sample will be checked to rule out infection. If the culture is negative — which it usually is — antibiotics are not the answer.
A course of anti-inflammatories (NSAIDs): A 2-week course of an NSAID such as meloxicam or naproxen helps a significant number of patients by addressing the underlying inflammatory component. This is often the first treatment tried and is effective for many.
Pelvic floor physical therapy (PFPT): For patients who don't fully respond to NSAIDs, pelvic floor physical therapy can be very helpful — particularly when pelvic floor tension or nerve sensitization is contributing. A PFPT specializing in men's pelvic health can identify and treat muscle tightness, trigger points, and guarding patterns that perpetuate the discomfort. This is not just about weak muscles — PFPT also addresses muscles that are too tight.
Time: In most cases, the discomfort does resolve on its own — it simply takes longer in some patients than others. Knowing that this is a known, recognized phenomenon rather than a sign something went wrong can itself be reassuring.
If you are experiencing persistent burning or discomfort beyond 2 weeks, please call the office so Dr. Childs can evaluate you and start a plan. You do not need to wait it out alone.
At your follow-up appointment, Dr. Childs will perform a uroflow and post-void residual (PVR) check — a non-invasive test that measures your urinary flow rate and how much urine remains in the bladder after you void. Please arrive with a comfortably full bladder so you are ready to provide a urine sample and complete the flow test. Try not to urinate for at least 1–2 hours before your appointment. If you arrive with an empty bladder, we will need to wait — which can extend your visit significantly.
Never hesitate to call. Our team would much rather hear from you than have you worry at home.