The First 24 Hours After HoLEP

In the recovery area

You wake in a monitored recovery room. Oxygen and heart monitors stay on while anaesthesia wears off.

Pain is usually mild and controlled by paracetamol, short-acting opioids if needed, and sometimes anti-inflammatories. You can usually sip water within an hour.

A catheter with a three-way port drains urine and allows saline to wash the bladder gently. This keeps the view clear as small clots pass.

Moving to the ward or day-case unit

Once your breathing, pulse, and blood pressure are stable, you transfer to the ward or the day-case bay. For a fit man with a smooth operation, this can be within an hour of leaving theatre.

On the ward, sit up, sip water, and eat light food once allowed. Team members encourage short walks — even to the bathroom and back — to reduce clot risk.

Your catheter stays in with its washout running. A sensation of the catheter is common, and sharp pain would be unusual and should be reported to the team.

Evening of the operation

By evening, the washout fluid slowly turns from pink to clear. Nurses monitor the rate and top up the bag as needed.

Many men eat dinner and drink normally. Sleep is usually possible with mild analgesia.

Tell your team if any of three things happen: heavy red blood in the bag, increasing lower belly pain, or difficulty passing tiny amounts around the catheter. Each has standard clinical steps to address it when flagged early.

The first morning

A ward round at first light checks the washout colour and your comfort. If urine is pink or clear and you have walked, the catheter can often come out that day.

Men on structured day-case pathways may go home the same evening or the next morning. Men with larger glands or on blood thinners stay slightly longer.

Breakfast is normal. Paracetamol continues as needed. Walking longer distances begins today.

Catheter removal

Removing the catheter is quick. A nurse deflates the small balloon inside the bladder and pulls the catheter out in one smooth motion.

Many men feel a brief tug. Urine passage typically resumes once the bladder has filled, though timing varies.

The first pass of urine may sting briefly. This usually fades over the next few times.

What your first stream looks like

The first urine is usually pink or pale red. A washed-out rose colour is within the normal range.

Published series report a stronger urinary flow after HoLEP in men with baseline outlet obstruction; the degree of change depends on baseline symptoms and individual recovery.

A more complete sense of emptying is also reported in published series; whether it returns depends on pre-operative bladder function.

What can still go wrong in 24 hours

Delayed urinary retention, where the bladder temporarily stops emptying after catheter removal, is uncommon but does happen. A recent study characterised this delay in a cohort of post-HoLEP patients[¹].

Heavy bleeding with clots can happen in the first day, even after a smooth operation. This needs immediate review.

A new fever over 38 degrees, or cloudy foul-smelling urine, may signal a urinary infection that needs treatment.

Home instructions at discharge

Written instructions cover fluids, pain medicines, activity limits, and warning signs. A contact number is given for out-of-hours questions.

Drink water to keep urine pale. Avoid heavy lifting and long drives for a fortnight.

Follow-up dates are booked before you leave.

Plain bottom line

The first twenty-four hours follow a steady recovery path: wake, walk, eat, sleep, lose the catheter. Stream changes after catheter removal are commonly recorded within the same day in published series, and hospital discharge on post-op day 1 is typical for men on a standard pathway.