Before Your HoLEP: Pre-op Assessment

The pre-op clinic

A pre-op visit usually happens one to three weeks before surgery. It may be held in the urology clinic, in an anaesthetic clinic, or by phone in some centres.

The visit has three aims: check your general health, finalise the surgical plan, and confirm what you need to stop or continue on the day.

Bring every medicine bottle and supplement you take. Some affect bleeding, clotting, or blood pressure during the operation.

Your history and exam

Your clinician confirms symptoms, bother, and any changes since the last visit. Past surgeries, allergies, and heart or lung conditions come up again.

A focused abdominal exam is brief. A digital rectal exam is usually part of the pre-op clinic if it has not been done recently.

Your weight, blood pressure, and oxygen readings are taken as baseline.

Urine and blood tests

A urinalysis, a urine culture if symptoms suggest an infection, and a recent PSA are usual. An infection is treated before surgery.

Blood tests typically include full blood count, urea and electrolytes, and a clotting screen if you are on blood thinners. Extra tests depend on your background.

A recent ECG is asked for in men with cardiac history or above a certain age threshold.

Imaging and a uroflow

A recent ultrasound of the bladder and prostate helps plan the operation. It also records the prostate size that guides the surgical approach.

A uroflow test adds a number to the story. Your urologist may repeat the test if the recorded sample is small or unrepresentative of your usual pattern.

A post-void residual scan — measuring urine left in the bladder after you pass — sometimes shapes catheter plans. International urology guidelines recommend uroflowmetry, prostate imaging, and a post-void residual measurement in the work-up before surgery[¹].

Cystoscopy when needed

A flexible cystoscopy is not routine for every man. It is ordered when a bladder stone, a median lobe, or a stricture is suspected.

The test takes a few minutes in the clinic. Local anaesthetic gel numbs the urethra, and the camera gives a clear view.

If a finding changes the plan, your surgeon will discuss the implications before the operation.

Anaesthesia review

An anaesthetist reviews your fitness for general or spinal anaesthesia. Airway, recent respiratory infections, and reflux all come up.

Your plan is tailored to your history. Some men prefer spinal anaesthesia; others prefer to sleep through.

The anaesthetist also checks whether any sedative or pain medicine at home needs adjusting in the days before.

Medicines and supplements

Blood thinners, diabetes medicines, and some heart tablets need a specific plan. Stop-and-start dates are written on paper.

Some supplements — garlic oil, ginkgo, high-dose fish oil — can thin the blood. Your team will ask about these directly.

Never stop a prescription on your own without a medical team's input.

Fasting and arrival

Fasting instructions come from the anaesthetist, usually six hours for food and two hours for clear fluids. Water up to two hours before is allowed in many plans.

Arrive with paperwork, medicines, and loose comfortable clothing. A companion to help you home after discharge is standard.

On the day, your team reconfirms everything and marks the planned procedure.

Plain bottom line

Pre-op assessment exists to tune the plan to you. Bring your medicines, answer questions honestly, and keep the paper with stop-start dates close.

A calm pre-op clinic makes the operation day calmer.