Holmium laser enucleation of the prostate (HoLEP) can be performed safely as a same day outpatient surgical procedure regardless of prostate size, according to investigators.

In a retrospective study of 377 patients who underwent HoLEP from November 2013 through December 2018, investigators found that patients who underwent same day surgery (SDS) had post-operative complication rates and 30-day readmission rates that were not statistically different from those of patients admitted to a hospital overnight (non-SDS patients), a team led by Joel T. Funk, MD, of the University of Arizona in Tucson, reported in Urology. In addition, at 1 year follow-up, the 2 groups did not differ significantly with respect to maximum flow rate, post-void residual, or International Prostate Symptom Score.

Dr Funk and his collaborators defined SDS patients as those discharged directly from a post-anesthesia care unit. To be considered for SDS, they had to live within the local metropolitan area (defined as living within city limits), have immediate access to an emergency room, and have an ECOG 0-2 performance status. SDS exclusion criteria included any of the following: ECOG performance status 3-5, residence outside the local metropolitan area, unwillingness to be sent home with an indwelling catheter.

“The rationale of excluding patients for SDS was so that they would not have to make a long commute to clinic for their Foley catheter removal or in situations where patients may not have access to an emergency room if discharged.”


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Of the 377 patients, 199 met the criteria for SDS and 178 were categorized as non-SDS patients. Patients had a mean prostate volume of 89 cm3. The non-SDS group had a significantly higher proportion of patients with a history of urinary retention (54.5% vs 43.2%), lower mean preoperative maximum flow rate (5 vs 6 mL/s), and larger mean prostate volume (96 vs 83 cm3).

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The non-SDS group had a significantly longer mean operative time (132 vs 110 minutes) and longer mean length of stay (30.5 vs 3.9 hours average) that the SDS group.

“Same day outpatient surgery for HoLEP is both safe and feasible and should be considered regardless of prostate size, comorbidities, age, or anticoagulation status to decrease hospital stay and medical care costs,” the authors concluded. “HoLEP patients can be offered SDS if they live in relative close proximity, and have good functional status with ECOG 0-2. Other strict inclusion criteria or discharge criteria may not be necessary.”

Reference

Lwin AA, Zeng J, Evans P, et al. Holmium laser enucleation of the prostate is safe and feasible as a same day surgery [published online January 18, 2020]. Urology.  doi: 10.1016/j.urology.2020.01.014