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I Had Prostate Surgery and It Didn't Work. What Now?
Dr. Fernando Gómez Sancha · ICUA
Dr. Fernando Gómez Sancha · YouTube
Language: English. Editorial classification in the patient catalog.
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How to interpret retreatment figures
Retreatment rates depend on what counts as another intervention and on the follow-up period. A percentage without a stated follow-up cannot be directly compared with rates at five or ten years.
At five years, Epic Cosmos (2026) reported surgical retreatment of 4.4% for HoLEP/ThuLEP combined and 7.1% for TURP. This is an unadjusted observational comparison between groups; it does not establish superiority for every patient.
Editorial clarification based on the cited sources. It does not establish a new medical review of the video.
About this video
You had prostate surgery but the symptoms haven't improved? You're not alone. Many patients experience this frustration when the initial procedure fails to resolve the problem or symptoms return over time.
In this video, Dr. Gómez Sancha explains why certain prostate surgeries like TURP, Rezum, or UroLift can fail, what options exist when symptoms return, and how HoLEP laser surgery offers a definitive solution even after a previous failed procedure.
The data speaks clearly: the reoperation rate with HoLEP is less than 2%, compared to 14-17% with traditional minimally invasive techniques (MISTs). With over 10,000 HoLEP procedures performed and 32 years of experience, Dr. Gómez Sancha trains urologists in 50+ countries, offering solutions that truly work.
If your surgery didn't work, there's hope. A definitive solution exists.
Documented details and sources
Only details explicitly stated in the sources. Missing information does not mean it did not occur.
No clinical case details have been extracted for this video.
Original title and description on YouTubeSource checked: 2026-10-04.
Available transcript · English
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- Doctor, I had prostate surgery 3 years ago and I'm still getting up at night, still have a weak flow, still have the same symptoms. More patients say this than you'd imagine and it's frustrating, but there's an explanation and above all, a solution.
- I'm Dr. Fernando Gomez Sancha. I've been in urology 32 years and performed over 10,000 laser prostate enucleations. A big part of my practice is precisely these cases. Patients already operated on where the result wasn't as expected or worsened over time.
- Why does prostate surgery fail? The most common cause by far is the incomplete resection of the prostatic adenoma. The obstructive tissue wasn't fully removed and since it's tissue that grows, over time, if remnants are left, it'll grow and obstruct the urine flow again. The most common technique for decades has been transurethral resection of the prostate, scraping the tissue with an electric loop bit by bit from inside.
- The problem is that it depends heavily on the surgeon's experience and the size of the prostate. In large prostates, it's very difficult to resect all the tissue and a remnant always remains.
- The data confirms it. The reoperation rate after a transurethral resection can be 15 or 20% after 10 years. That means for every five or six patients with TURP, one will need to return to the operating theater in the next decade. With enucleation using a holmium laser, this reoperation rate drops to less than 2%. Why? Because HoLEP doesn't scrape, it enucleates. It separates all the tissue, so it's like peeling an orange. We remove the entire adenoma and since no tissue is left that can grow, well, the urethra doesn't get obstructed again.
- Doctor, if I've already had surgery once, can I have surgery again? Well, yes, absolutely yes. Reoperation using a holmium laser, a laser enucleation after a failed previous surgery is perfectly possible.
- It's technically more complex because there's scarring from the previous surgery, but with the experience we have, it can be done safely and very effectively. I've I've operated on hundreds of patients in this situation, patients who had come from having an incomplete transurethral resection or having undergone green laser vaporization that hadn't been enough, even previous open surgeries.
- Patients from all over Spain and from outside Spain who had lost hope. And I'll tell you one thing, they're some of the most grateful patients because they arrived thinking there was no solution.
- After the second operation done properly with a complete enucleation, they finally urinate well, finally sleep through the night, and finally regain their quality of life. So, how do you know when you need a reoperation?
- Well, if you had prostate surgery and still have a weak or intermittent flow, you're still getting up at night, notice the bladder doesn't empty completely, or need medication again, it's likely there's residual tissue obstructing again.
- An ultrasound and flow metry give your urologist all the information needed to assess if a second surgery is indicated. Often, we also perform a urodynamic study to know exactly how things are and what result we can expect from this second intervention.
- The message I want you to take away is this, just because a first surgery didn't work, doesn't mean there's no solution. HoLEP can definitively resolve what other techniques left incomplete.
- If you're in this situation, don't just give up. Consult, get informed, and look for a urologist with experience in laser enucleation. Subscribe for more information, and I'll see you in the next video.