How to read this guide
Three kinds of information appear on this page, and they are labelled as such.
Findings about the operation in general.
Studies of en bloc surgery, early apical release or mucosal preservation.
Results from one surgeon or institution, which may not generalise elsewhere.
A note from the surgeon
Why I wrote this guide
Every week I receive messages from men in other countries who have already been told what operation they need. Far fewer have been told why, what the honest trade-offs are, or what the days after surgery actually look like when home is a flight away.
This guide is my attempt to answer those questions before we meet. It explains what HoLEP is, what the words en bloc and early apical release mean, what our published results show and, just as importantly, what they cannot promise. It also sets out how an international assessment should work, step by step, so that nobody books a flight before the case has been reviewed.
Two principles guide the text. First, the name of an operation is never enough: results depend on the right diagnosis, careful technique, an experienced team and follow-up that does not end at the airport. Second, numbers belong to groups of patients, not to you. Where I quote a figure, I say where it comes from.
Dr Fernando Gómez Sancha · Urologist, Madrid
Urgent symptoms
Inability to urinate, heavy bleeding or clots, fever, chest pain, shortness of breath, leg swelling or confusion require urgent local medical care, not an email.
Start here
The short answer
HoLEP removes the prostate tissue that is blocking urine flow. It is performed through the urethra, without an abdominal incision, and can be used for prostates of very different sizes.
En bloc HoLEP is a refined way of performing the enucleation. The surgeon follows the anatomical plane around the adenoma as one continuous unit, releasing the tissue beside the urinary sphincter early and preserving its protective mucosa whenever possible.
The operation's name is not a guarantee. Good results depend on correct diagnosis, careful technique, an experienced team and proper follow-up.
In one sentence
HoLEP takes out the blockage through the natural passage; en bloc describes how carefully the surgeon follows the plane around it; neither word replaces experience.
Is this guide for me?
This guide is for men whose urinary symptoms may be caused by benign prostatic hyperplasia (BPH) and who are considering surgery. HoLEP may be relevant if:
- medication no longer controls your symptoms or causes unacceptable side effects;
- you have recurrent urinary retention or depend on a catheter;
- you have repeated infections, bladder stones or bleeding linked to obstruction;
- your bladder or kidneys are being affected;
- you have a large prostate and want a tissue-removing treatment;
- obstruction has returned after previous prostate treatment.
Prostate size alone does not decide treatment. Bladder function, anatomy, general health, medication, previous procedures and your priorities all matter.
When HoLEP may not be the first plan
HoLEP is normally postponed in the presence of an untreated urinary infection or an uncorrected bleeding disorder. Severe urethral narrowing may prevent safe endoscopic access and may need separate treatment. If assessment suggests a prostate cancer that requires cancer-directed surgery, a benign-obstruction operation may not be the appropriate first treatment. These are clinical decisions, not exclusions a patient should apply to himself.
Understanding the problem
What an enlarged prostate does, and what HoLEP does about it
What does an enlarged prostate do?
The prostate surrounds the first part of the urethra. As its inner tissue enlarges, it can compress the urinary channel. Common symptoms include a weak stream, difficulty starting, straining, incomplete emptying, urgency, frequency, waking at night and complete urinary retention.
A proper assessment may include urine and blood tests, PSA history, urinary-flow and residual-volume measurements, ultrasound or MRI, cystoscopy and sometimes urodynamics. The aim is to confirm that prostate obstruction is the main problem. Surgery can remove an obstruction; it cannot guarantee that every bladder symptom will disappear.
What happens during HoLEP?
The surgeon passes an endoscope through the urethra. A holmium laser separates the enlarged inner tissue, the adenoma, from the compressed outer surgical capsule. Think of removing the flesh of an orange while leaving the peel in place. The released adenoma is moved into the bladder, divided with a morcellator and removed through the urethra. The tissue is then sent for pathological examination.
This is different from simply widening a channel by cutting or vaporising part of the obstruction. Enucleation aims to remove the obstructing adenoma along its anatomical plane.
HoLEP is not an operation for prostate cancer
HoLEP treats benign urinary obstruction. The outer prostate remains, PSA does not fall to zero and future prostate-cancer screening may still be required.
Technique
What “en bloc” means, and why the apex matters
Traditional HoLEP was commonly taught by dividing the adenoma into two or three lobes. En bloc surgery follows it as one continuous anatomical structure. It does not mean that the whole prostate leaves the body intact: en bloc describes the enucleation, and the adenoma still needs to be morcellated for removal.
The apex is where the enlarged prostate meets the external urinary sphincter, the muscle that keeps you dry. Early apical release is designed to define and free this critical area first, before the rest of the adenoma creates traction on it, while preserving the delicate mucosa over the sphincter.
Published studies support en bloc HoLEP as an effective and efficient technique, but they do not prove that the label alone prevents incontinence. Modern apical dissection, mucosal preservation and surgeon experience matter more than terminology.
Outcomes
What can I realistically expect?
The goals are a stronger stream, better emptying, less straining and durable relief of obstruction. Urgency and night-time urination may improve more slowly, especially if the bladder has been obstructed for a long time.
Published ICUA results
Group results, not promises.
These studies support the use of en bloc HoLEP in experienced hands, including for large prostates. They cannot predict one person's recovery.
Choosing
How does HoLEP compare with other options?
There is no universally best operation. The right choice depends on anatomy, prostate size, health, priorities, local expertise and the trade-offs you are willing to accept.
Scroll the table sideways to see every column →
| Option | What it does | Potential reason to choose it | Important trade-off |
|---|---|---|---|
| Medication | Relaxes the prostate or slows growth | Avoids or postpones surgery | Does not remove the obstruction; effects and side effects vary |
| Water-vapour therapy (Rezūm®) · prostatic urethral lift | Treats selected tissue with a minimally invasive approach | May better preserve ejaculation in selected anatomy | Usually less tissue removal; not suitable for every size or shape |
| TURP | Cuts a channel through obstructing tissue | Established option, especially for small or medium glands | Removes tissue differently from anatomical enucleation |
| Aquablation® | Removes tissue with a robotically controlled waterjet | Strong symptom relief; possible ejaculatory advantage in selected men | Bleeding, anatomy, durability and retreatment should be discussed |
| HoLEP | Anatomically enucleates the obstructing adenoma | Size-independent tissue removal, no abdominal incision, tissue available for pathology | Loss of forward ejaculation is expected; specialised expertise matters |
| Simple prostatectomy | Removes the adenoma through an abdominal or robotic approach | Effective for very large glands or when abdominal surgery is otherwise needed | More invasive; typically longer catheterisation and hospital stay |
Very large prostates
Open or robot-assisted simple prostatectomy remains an effective option for very large glands. In a 2025 propensity-matched study of prostates of at least 80 g, en bloc HoLEP and robot-assisted simple prostatectomy had comparable three-month functional outcomes; HoLEP had shorter hospitalisation and catheterisation. The study was not randomised.8
Published ICUA data include 110 prostates of at least 120 g treated with en bloc HoLEP, with favourable functional outcomes.9
Do not ask only “Which technology do you have?” Ask “Why is this option best for my anatomy, my bladder and my priorities, and what are your own audited outcomes?” The laser brand matters less than the team using it.
Take this list to any consultation
Ten questions to ask your surgeon
- How many HoLEP procedures do you perform each year?
- How many have you performed with this specific technique?
- Do you regularly treat prostates of my size and patients with my history?
- What are your own rates of transfusion, readmission, persistent incontinence, stricture and retreatment?
- How do you define and measure continence?
- What is your usual catheter and discharge pathway, and what can make it longer?
- What happens if I cannot urinate after catheter removal?
- Who answers urgent questions after discharge?
- Will all removed tissue be examined by pathology?
- What outcome is realistic given my bladder function, not just my prostate size?
These questions are designed to be taken to any consultation, including a second opinion closer to home.
Being honest about trade-offs
Risks and trade-offs you should know
Ejaculation and fertility
Loss of forward ejaculation (retrograde ejaculation) is expected in most patients after standard HoLEP. Orgasm and erections can remain intact, but fertility is affected. If ejaculation or future fertility matters to you, say so before choosing treatment.
Temporary leakage
Stress leakage with coughing or movement and urgency-related leakage can occur early after catheter removal. Most improves with healing and pelvic-floor rehabilitation, but persistent incontinence is possible.
Other risks
Bleeding, infection, temporary retention, urethral or bladder-neck scarring, anaesthetic complications and the need for another procedure are possible. Occasionally, pathology finds previously unsuspected prostate cancer.
Blood thinners
Medicines that affect clotting must never be stopped without an individual plan agreed by the prescribing doctor and the surgical team.
Orientation, not a personal schedule
Your recovery timeline
Endoscopic enucleation under general or spinal anaesthesia; catheter placed.
No abdominal incision; removed tissue goes to pathology.
Irrigation if needed, walking, drinking and catheter assessment.
In the 137-patient ICUA publication, mean catheterisation and stay were 1.2 days; a group average, not a discharge promise.2
Many patients are urinating without a catheter; others need more time.
Discharge depends on bleeding, infection, urination and general recovery.
Variable stream, frequency, urgency, tiredness or small amounts of blood.
Avoid heavy exertion; follow hydration, work, sex and emergency instructions from the team.
Control and bladder symptoms continue to settle.
In the published series, stress leakage declined from 5.8% at one month to 1.5% at three.2
Functional review, PSA plan and longer-term follow-up.
Persistent leakage, infection, poor flow or bleeding requires assessment; the series reported 0.7% stress incontinence at six months.2
Your surgeon's instructions take priority over any generic schedule, including this one.
Straight answers
Frequently asked questions
Will I be dry immediately?
No surgeon can promise this. Many patients are dry early; others have temporary stress or urgency leakage. Persistent leakage is uncommon in experienced series but remains a real risk.
How long will I have a catheter?
In the published ICUA series of 137 patients, mean catheterisation was 1.2 days.2 An individual may need it for less or longer depending on bleeding, bladder function and the ability to urinate after removal.
When can I fly home?
There is no universal flight day. The operating team assesses bleeding, urination, catheter status, infection risk, general health and flight duration. Keep travel plans flexible.
When can I return to work, exercise and sex?
Light activity usually returns before heavy lifting, strenuous exercise or sex. Your discharge instructions give individual dates; a generic internet schedule should not override them.
Will I need pads?
Some men use a light pad temporarily for stress or urgency leakage. Others are dry immediately. Persistent or worsening leakage should be reviewed and may benefit from supervised pelvic-floor rehabilitation.
Is HoLEP painful?
There is no abdominal wound, but the catheter can be uncomfortable and burning, urgency or bladder spasms may occur. Pain that is severe, increasing or associated with fever requires assessment.
What happens to blood thinners?
Never stop them yourself. The plan depends on why you take them, the specific drug and your bleeding and clotting risks, and must be agreed by the surgical team and the prescribing clinician.
Will nocturia disappear?
Not always. Night-time urination can improve when obstruction is relieved, but it may also reflect bladder overactivity, sleep disorders, fluid balance, diabetes, heart conditions or other causes.
Will my erections change?
HoLEP is not intended to treat erectile dysfunction. Many men maintain erectile function. The expected sexual change after standard HoLEP is loss of forward ejaculation.
Can the prostate grow back?
The outer prostate remains, but most obstructing adenoma is removed. HoLEP is a durable tissue-removing treatment; no operation carries a literal lifetime guarantee. In the ICUA 754-patient en bloc cohort, retreatment within follow-up was below 2% (centre audit data); a large US registry reports a five-year retreatment rate of about 4.4% after HoLEP/ThuLEP, lower than TURP (7.1%) and far lower than minimally invasive treatments such as Rezūm® (14%) or prostatic urethral lift (16%).11
Does a very large prostate require open surgery?
Not necessarily. Published ICUA data include 110 prostates of at least 120 g with favourable functional outcomes.9 Anatomy, bladder conditions, previous surgery and local expertise still matter.
Is en bloc always better than standard HoLEP?
No. En bloc surgery can improve operative efficiency, but continence findings vary between studies. A well-performed modern lobe-based HoLEP is preferable to poorly performed en bloc surgery.
What does it cost?
We do not publish a fixed price, because the cost depends on the assessment, the operation and the length of stay. If you contact us with your medical records, you will receive a written quotation stating what is and is not included, together with the estimated time in Madrid and what would change the plan. Ask your insurer in advance about cover limits for planned treatment abroad.
What happens if I have a problem after I return home?
Care does not end when you board the flight. Before discharge you receive a discharge summary, warning signs and a 24-hour emergency route, and the follow-up plan states which symptoms need local examination rather than a video call. With your consent, a structured handover — operative report, discharge summary, pathology and follow-up questions — goes to your urologist at home, so that local assessment does not start from zero. Symptoms that need urgent care must always be assessed locally.
International patients
Travelling to Madrid for en bloc HoLEP
Travelling for surgery raises questions a technical explanation cannot answer: which records are needed, how long to stay, when it is safe to fly, and who helps if something happens after you return home. This is how an assessment should work; it is not a fixed package and does not replace an individual medical plan.
Send the right information
Symptoms and when they began · medication and allergies, especially blood thinners · major conditions and anaesthetic problems · PSA history, MRI, biopsies · ultrasound or MRI with prostate volume · flow and residual volume if available · previous prostate or urethral procedures · catheter use, infections, stones, bleeding, retention · your priorities: continence, ejaculation, travel.
Do not attach medical records to a plain e-mail or social-media message. Send documents with a password-protected SwissTransfer link, as explained in the case-review section below.
Initial review and formal consultation
The team first checks that the documentation is complete. Dr Gómez Sancha then evaluates whether a formal consultation is warranted, which tests are missing and whether HoLEP appears relevant. This preliminary review is an orientation on whether a formal consultation is worthwhile, not a diagnosis or a treatment recommendation; the surgeon performs it under professional secrecy and it is recorded.
At the consultation you should receive: the likely diagnosis and its uncertainties, reasonable alternatives including options closer to home, an individual discussion of benefit and risk, a written quotation stating what is and is not included, the estimated time in Madrid, and what would change the plan.
Planning the journey
Do not book non-refundable travel until the clinical team has reviewed the case and confirmed a provisional schedule. Plan for: arrival early enough for in-person review and remaining tests · a companion when advisable · accommodation with easy access · transport without heavy lifting · regular medication · insurance limits for planned treatment abroad · flexibility if catheterisation or admission lasts longer. Most patients plan 5–7 days in Madrid; the surgeon decides when it is safe to fly.
Assessment in Madrid
Identity, records, medication, urine status, anaesthetic fitness and informed consent are confirmed. The consultation explicitly covers why surgery is recommended, why HoLEP over reasonable alternatives, continence and sexual trade-offs, blood-thinner management, catheter and discharge expectations, warning signs and emergency arrangements, and what happens if surgery reveals an unexpected finding.
Surgery and discharge
Discharge depends on clinical status. Before leaving hospital you receive: a discharge summary · medication and activity instructions · catheter instructions if relevant · warning signs and a 24-hour emergency route · the pathology and follow-up plan · a fit-to-fly decision process · contacts for routine and urgent questions.
Recovery in Madrid
Blood-stained urine, frequency, urgency, burning, tiredness and variable control can occur early; bleeding can briefly increase after activity or as healing tissue separates. The operating team decides when you can leave Madrid. A fixed flight date must not override bleeding, infection, retention or catheter concerns. You will know where to go locally if urgent assessment is needed outside the clinic.
Flying home
Fitness to fly depends on stable urination and acceptable bleeding, whether a catheter remains, infection or fever, anaesthetic and cardiovascular risk, flight duration and mobility, and access to care at the destination. Carry medication, discharge documents and emergency contacts in hand luggage; follow individual advice on hydration, mobility and thrombosis prevention.
Follow-up at home
Care is not complete when you board the flight. The plan specifies when pathology will be available and who explains it, when symptoms, continence and flow are reviewed, what PSA follow-up is needed, which symptoms need local examination rather than a video call, and how the operating team communicates with your local urologist. With your consent, a structured handover goes to your urologist at home.
Who will look at your case
About the surgeon
Fernando Gómez Sancha is a urologist and Medical Director of ICUA (Instituto de Cirugía Urológica Avanzada) at Clínica CEMTRO in Madrid. He specialises in anatomical endoscopic enucleation and en bloc HoLEP with early apical release, teaches the technique to urologists internationally, and is the author of The En Bloc HoLEP Manual (also available in Spanish).
He is first author of the 2015 paper describing the move towards anatomical enucleation and an en bloc approach,1 senior author of the 2019 technique series,2 and co-author of the multicentre studies on early apical release and en bloc enucleation cited in this guide.5,6,9
Experience figures and disclosure
Large experience figures should help you ask better questions; they do not replace individual assessment or guarantee an outcome. Biographical figures establish exposure and educational reach and are kept separate from clinical outcome claims.
Disclosure: Dr Gómez Sancha has acted as a paid consultant for Quanta System and Lumenis (laser manufacturers), as declared in the cited publications.6
Next step
Request a confidential case review
Send your clinical information for a confidential preliminary review. The team will tell you what is missing, whether a formal consultation is appropriate and what the next step would be.
First contactfgs@icua.es — please do not attach medical records
Response timea member of our clinical team replies within 24–48 h
How to send documents securely
Medical records must not travel as attachments to a plain e-mail or as social-media messages. Write first to fgs@icua.es without attachments, and send your documents with SwissTransfer, a free service with servers in Switzerland that requires no account: upload your documents there, protect the transfer with a password and e-mail us the download link, with the password in a separate message. Files are kept for a maximum of 30 days and are then deleted automatically.
What to prepare
- a short symptom and medical history
- medication, especially blood thinners
- PSA history, MRI and previous biopsy results
- prostate ultrasound or MRI with measured volume
- urinary-flow and residual-volume results, if available
- previous prostate procedures
- catheter, infection, stone or bleeding history
- your priorities, including continence and ejaculation
Submitting information does not establish a doctor-patient relationship, confirm suitability for HoLEP or guarantee acceptance for surgery. Emergency symptoms must be assessed locally and never managed through email or social media.
Privacy (summary)
Controller: Instituto de Cirugía Urológica Avanzada, S.L., Madrid. Purpose: preliminary assessment of your case and, if you wish, arranging a consultation. Basis: your explicit consent and healthcare provided under professional secrecy (GDPR art. 9.2.a, 9.2.h). Seen only by the clinical team; kept for as long as needed for your care; never sold or shared. Access, rectify, erase or withdraw at icua@icua.es. Full policy: icua.es/aviso-legal.
Appendix for referring urologists and colleagues
The evidence in brief
En bloc HoLEP replaces segmented lobe-by-lobe enucleation with a continuous anatomical dissection; modern variants add early apical release and sphincteric mucosal preservation. The most consistent comparative signal is operative efficiency. Continence findings are favourable in several series but not uniform across comparative datasets.
Key studies
137 consecutive single-surgeon patients, mean volume 75.6 mL (to 253); mean surgery 47.6 min; SUI 5.8 / 1.5 / 0.7% at 1, 3, 6 months. Observational, no control arm.
600 patients randomised to en bloc, two-lobe or three-lobe. En bloc and two-lobe were faster than three-lobe; postoperative outcomes similar. A counterweight to superiority claims.
168 patients, single expert surgeon: shorter enucleation and operating time, lower energy and less one-month stress incontinence with en bloc. Non-randomised.
5,068 patients, multicentre: overall incontinence similar early and at three months; absence of early apical release associated with persistent stress incontinence in multivariable analysis.
4,392 patients, eight centres, 787 per matched arm: incontinence similar with and without early apical release; longer operating time and more early complications (haematuria, transfusion) in the release group. An important negative study.
500 consecutive en bloc cases: efficiency kept improving; no deterioration in complications, catheterisation or stay.
754 single-surgeon procedures (644 ≤ 120 g, 110 ≥ 120 g): favourable outcomes in both groups; six-month SUI 0.15% vs 0.9%, p=0.27. Not a comparison with another technique.
123 patients > 80 mL randomised: en bloc reduced enucleation and operating time and energy; complications and transient incontinence comparable. Both arms used early apical release and mucosal preservation.
What can be claimed responsibly
Supported
Feasible, effective and reproducible in experienced hands · consistently shorter operative or enucleation time and lower energy in comparative studies · applicable to very large prostates in high-volume settings · early apical release and mucosal preservation are coherent principles worth explicit training · durability: in a 6.45-million-patient US registry (Epic Cosmos, 420,611 procedures, 2014–2024), five-year retreatment after HoLEP/ThuLEP was 4.4%, below TURP (7.1%) and minimally invasive treatments (Rezūm® 14%, prostatic urethral lift 16%); only simple prostatectomy was lower (1.2%).
Should be qualified
Evidence for superior early continence is mixed · observational series cannot prove that the technique alone caused the outcome · “size independent” describes technical range, not equal risk for every patient · centre-specific results need denominator, definition and time point.
Should not be claimed
Guaranteed continence · universal superiority over every modern HoLEP variant · a benefit derived from the words “en bloc” alone · generalisability of expert single-surgeon outcomes to every centre.
Shared care of international patients
If you are the treating urologist of a patient considering en bloc HoLEP in Madrid, we work in a shared-care model rather than around you. Before surgery, your assessment and records are part of the case review; after surgery, with the patient's consent, you receive a structured handover — operative report, discharge summary, pathology and the follow-up plan, including which findings warrant local examination — and follow-up is agreed between both teams rather than improvised across time zones.
To discuss a case, write to fgs@icua.es identifying yourself as the treating urologist, with a short clinical summary and your specific questions — no attachments in the first message. A member of the clinical team replies within 24–48 h. Urologists interested in training in the technique are welcome to say so in the same message.
The reference book
The En Bloc HoLEP Manual describes the technique step by step — anatomical landmarks, early apical release, mucosal preservation and troubleshooting.
English edition →Spanish edition — Manual de HoLEP en Bloque →
Sources
References
- Gomez Sancha F, et al. Common trend: move to enucleation—Is there a case for GreenLight enucleation? Development and description of the technique. World J Urol. 2015;33(4):539-547. PMID 24929643.
- Saitta G, et al. (senior author Gómez-Sancha F). 'En Bloc' HoLEP with early apical release in men with benign prostatic hyperplasia. World J Urol. 2019;37(11):2451-2458. PMID 30734073.
- Rücker F, Lehrich K, Böhme A, Zacharias M, Ahyai S, Hansen J. A call for HoLEP: en-bloc vs. two-lobe vs. three-lobe. World J Urol. 2021;39(7):2337-2345. PMID 33486536.
- Tuccio A, Sessa F, Campi R, et al. En-Bloc Holmium Laser Enucleation of the Prostate with Early Apical Release: Are We Ready for a New Paradigm? J Endourol. 2021;35(11):1675-1683. PMID 33567966.
- Castellani D, et al. Incidence of urinary incontinence following endoscopic laser enucleation of the prostate by en-bloc and non-en-bloc techniques: a multicenter, real-world experience of 5068 patients. Asian J Androl. 2024;26(3):233-238. PMID 38265232.
- Gauhar V, et al. Influence of Early Apical Release on Outcomes in Endoscopic Enucleation of the Prostate: Results From a Multicenter Series of 4392 Patients. Urology. 2024;187:154-161. PMID 38467289.
- Wenk MJ, et al. The long-term learning curve of holmium laser enucleation of the prostate (HoLEP) in the en-bloc technique: a single surgeon series of 500 consecutive cases. World J Urol. 2024;42(1):436. PMID 39046537.
- Choudhary MK, et al. Comparative Outcomes of En-Bloc Holmium Laser Enucleation of the Prostate and Transvesical Robot-Assisted Simple Prostatectomy for the Management of Benign Prostatic Hyperplasia: A Propensity-Matched Analysis. J Endourol. 2025;39(1):57-63. PMID 39589800.
- Iscaife A, Rodríguez Socarrás M, Talizin TB, Nahas WC, Fernandez del Alamo J, Cuadros Rivera V, Gómez Sancha F, et al. Contemporary results of En Bloc HoLEP for large prostates. World J Urol. 2025;43(1):401. PMID 40586952.
- Elmorsy YH, et al. A randomized controlled trial comparing en-bloc vs lobe-by-lobe HoLEP: surgical efficiency and early continence outcomes. Prostate Cancer Prostatic Dis. 2026;29(3):551-557 (published online 6 Nov 2025). PMID 41198920.
- Carletti F, Tamborino F, Turcan A, et al. Five-year Retreatment and Medication Restart Rates Following Benign Prostate Hyperplasia Treatments: A Nationwide Real-world Analysis Using Epic Cosmos. Eur Urol Focus. 2026;12(3):383-392. PMID 41558957.
Transparency
Fernando Gómez Sancha is first author of reference 1, senior author of reference 2 and a co-author of references 5, 6 and 9; reference 9 identifies him as the single operating surgeon. Reference 6 declares that he is a paid consultant for Quanta System and Lumenis.
Questions about this guide?
Educational assistant: answers only from this guide. It does not assess individual cases and is not medical advice. Please do not include personal data — the conversation is not stored.
Urgent symptoms? Seek local medical care immediately.