Day-case holmium laser enucleation of the prostate

Abstract

In 2011 day-case prostate surgery was selected for financial incentives in the UK by the Department of Health Payment by Results (PbR) scheme, with a target of 30% of holmium laser enucleation of the prostate (HoLEP) procedures as day cases for 2011-2012, increasing to 90% within three years. The objective was to determine the feasibility and safety of day-case HoLEP. Patients and methods: All patients presenting to an experienced HoLEP surgeon and requiring prostatic surgery were considered for day-case HoLEP. We developed a four-hour postoperative discharge protocol with specialist urology nurse assessment and discharge. Results: Between April 2011 and March 2014, 188 patients (median age 74, range 48-92) were eligible for HoLEP surgery. Four patients did not undergo surgery, and 70 (38%) did not fit the day-case criteria. The remaining 114 (62%) were considered for day surgery, of which 91 (80%) were successful. There was one readmission with haematuria and blocked catheter, and two late readmissions with secondary bleeding. Conclusions: Day-case HoLEP is feasible and safe, even in patients with significant comorbidity. Our overall day-case rate of 49.5% exceeds the initial 30% target set by PbR, but suggests that the 90% target is overly optimistic. KeywordsBenign prostatic hyperplasia, day-case surgery, holmium laser enucleation of the prostate Date

Day-case holmium laser enucleation of the prostate: feasibility, safety and predictive factors

“…In a larger study with 184 patients by Cynk et al, 14 the authors demonstrated an overall successful day-case rate of 49.5%, greater than that of our study. Patients were excluded on the basis of medical comorbidity including ASA grade greater than 3 and anticoagulation that could not be stopped, but additionally logistical factors (i.e.…”

Safety and Feasibility of Outpatient Surgery in Benign Prostatic Hyperplasia: a Systematic Review and Meta-Analysis

“…Only two studies 20,36 did not report failure events among the patients included in their analysis and therefore were not considered in the quantitative synthesis. In total, 18 studies 18,19,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]37 reporting data on immediate hospital readmission and/or inability to discharge after the endoscopic procedure presented different FR estimates ranging from 1.7% to 51.1%. Demographic and perioperative characteristics of the 18 studies analyzed are further presented in Table 2.…”

“…Subgroup analysis according to type of surgical technique. In total, five studies [32][33][34][35]37 implementing Greenlight, nine articles with HoLEP, [23][24][25][26][27][28][29][30][31] and four with TURP 18,19,21,22 were, respectively, reviewed. Test for differences among subgroups revealed the presence of a SAFETY OF BPH SURGERY ON OUTPATIENT SETTING statistical difference among the three different approaches (Q = 13.32, df = 2, p < 0.001).…”

“…Information regarding urethral catheter at discharge was available on 15 studies. Out of these, 11 18,21,23,[25][26][27][28][29][30][31]37 and 4 studies 22,32,33,35 reported discharge with and without catheter, respectively. We found that there was evidence for difference among the two subgroups analyzed (Q = 4.5, df = 1, p = 0.03).…”

“…Preoperative recorded ASA scores were identified from 17 studies. 18,19,[21][22][23][24][25][26][27][28][29][30][31][32][33]35,37 Out of these, 6 studies 18,19,[21][22][23]29 included only patients with a preoperative score of I or II, while the remaining 11 studies [24][25][26][27][28][29][30][31][32][33]35,37 enrolled patients presenting with any ASA score. Test for homogeneity among the two subgroups demonstrated no significant difference between the adoption of a different ASA score inclusion criterion (Q = 2.03, df = 1, p = 0.15).…”