Study finds 80% of low-risk men can be treated without hospitalization.
CLEVELAND—Outpatient holmium laser enucleation (HoLEP) of the prostate for treating BPH is safe and feasible, improves voiding function, and decreases symptoms of bladder outlet obstruction, researchers at the University of British Columbia in Vancouver conclude.
“At most institutions, patients traditionally get admitted to the hospital, whether for one day or multiple days, but our current standard is to treat these patients as outpatients,” said lead investigator Michael K. Eng, MD. “After surgery, they stay in the recovery room for four hours
and often leave [for] home with a catheter. The catheter is removed the following day.” He and his colleagues have been performing HoLEP as an outpatient procedure in low-risk men since 2003. Dr. Eng reported his findings here at the 24th World Congress of Endourology.
He presented data from 82 men who underwent planned outpatient HoLEP between October 2003 and March 2006. Men with large pros-tate sizes were not excluded from outpatient treatment. The 82 men were assessed at three and six months postoperatively using American Urological Association (AUA) symptom scores, peak flow rates, and post-void residual volumes.
The average age of the patients was 71 years. Preoperatively, their mean AUA symptom score was 20, their mean peak flow rate was 9.0 mL/sec, their mean bother score was 4, and their mean post-void residual volume was 194 mL. The total operating time was a mean of 80 minutes. The median prostate specimen weight was 71 g.
“We found that 80% could be done as outpatients,” said Dr. Eng, chief resident of urology. “Twenty percent needed to be admitted, most of the time for bleeding following the procedure, or they had medical comorbidities that precluded them from safely going home on the day of surgery.”
Short-term results were good. The AUA symptom score dropped to approximately 9 at three months and fell to 4.5 at six months. Bother score decreased to 2 at three months and to 1 at six months. Peak flow rates increased to 19 and 19.9 mL/sec at three and six months, respectively. Post-void residual volumes fell to 40 mL at three months and 60 mL at six months.
Dr. Eng also presented data from a series of 24 high-risk patients who had the procedure performed on an inpatient basis because of comorbidities. At the time of HoLEP, 37.5% of the patients were on anticoagulant therapy. Their average postoperative length of stay was 24.6 hours and the average duration of catheterization was 55.2 hours. The median prostate specimen weight resected was 67 g.
Symptom scores, bother scores, peak flow rates, and post-void residual volumes improved from baseline to three and six months following HoLEP.
“We showed that we can safely do HoLEP in high-risk men and it has efficacy equal to that in patients with less comorbidities,” Dr. Eng said.
In a separate study, researchers at the Methodist Hospital Institute for Kidney Stone Disease in Indianapolis found that age does not affect HoLEP outcomes. The 579 studied HoLEP patients: 104 who were aged 80 years and older and 475 patients younger than 80. The older patients had a larger mean preoperative prostate size (112.3 vs. 101.3 g), as determined by transrectal ultrasound. The older group did not differ from the younger group with respect to amount of tissue retrieved (84.1 vs. 77 g), operative time (109 vs. 116 minutes), length of postoperative catheterization (18.7 vs. 18.1 hours), or length of hospital stay (30.5 vs. 30.1 hours). The two groups had similar complication rates (five vs. six) and follow-up AUA symptom scores (6.5 vs. 6.7).