Holmium Laser Enucleation of the Prostate Is Safe and Feasible as a Same Day Surgery

Lwin, Aye Aye; Zeng, Jiping; Evans, Patrick; Phung, Malcolm; Hynes, Kieran; Price, Elinora; Twiss, Christian O.; Tzou, David T.; Funk, Joel

doi:10.1016/j.urology.2020.01.014

Cited by 37 publications

(49 citation statements)

References 18 publications

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“…The successful application of same day catheter removal for prostates <250 grams is encouraging as HoLEP by nature is size independent 1 , 2 and would apply to the vast majority of patients undergoing HoLEP. The rate of passage of voiding trial on the same day as surgery is also similar to recent studies, 11 , 12 demonstrating there is no added risk to patient of catheter reinsertion after BPH procedures.…”

Section: Discussionsupporting

confidence: 85%

“…Although patients with very large glands (>250 ml on preoperative imaging) were excluded from this approach, our cohort's prostate volume is similar to other outpatient HoLEP series 6 , 7 , 11 , with a wide range of 37-235 ml. The successful application of same day catheter removal for prostates <250 grams is encouraging as HoLEP by nature is size independent 1 , 2 and would apply to the vast majority of patients undergoing HoLEP.…”

Section: Discussionmentioning

confidence: 69%

“… 12 , 13 Multiple studies have demonstrated feasibility of HoLEP as an outpatient case, 7 , 8 , 9 , 10 including two recent studies. 6 , 11 This series builds off the previous work by removing the catheter on the same day as the procedure, HoLEP can be transitioned to a a true single day encounter for the patient. Our cohort did not experience significant dysuria, incontinence or postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

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Catheter Removal on the Same Day of Holmium Laser Enucleation of the Prostate: Outcomes of a Pilot Study

Agarwal

Rivera

Nottingham

et al. 2020

Urology

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Objectives To determine if same day catheter removal is feasible in select population after holmium laser enucleation of the prostate (HoLEP). Methods We performed an analysis of patients undergoing HoLEP at our institution who underwent same-day catheter removal after HoLEP. All HoLEPs were performed with Moses Optimized for BPH. Patients were dismissed from postoperative recovery unit (POCU) to the clinic for catheter removal and voiding trial. Results To date, 30 patients have undergone same day catheter removal. Median age is 68.6 years (IQR 61.8-73.3) and preoperative prostate volume 81 ml (IQR 53-114.8). Median enucleation time was 39.5 min (IQR 30.5-53), morcellation time was 5 min (IQR 4-12 min) and enucleated specimen weight was 52.5 g (IQR 33-81). 27 (90%) patients successfully voided on the same day without requiring catheter replacement. All patients were catheter free by POD1. For patients who successfully passed their voiding trial, the median time from the end of the procedure to hospital discharge was 2.6 hours (IQR (2.1-2.9) and from the end of the HoLEP to catheter removal was 4.9 hours (IQR 3.5-6.0). Conclusions We present for the first time that same day catheter removal is a feasible option in a select population of patients undergoing HoLEP. With more study, this has the potential for transforming the management of BPH, especially larger glands.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Catheter Removal on the Same Day of Holmium Laser Enucleation of the Prostate: Outcomes of a Pilot Study

Agarwal

Rivera

Nottingham

et al. 2020

Urology

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“…Our cohort differs from others in a lack of restrictions on prostate volume [13,17], patient comorbidity score [13,17,18], or AC use [13,17]. However, clinical judgment and consultation with the patients' other medical physicians were used in planned admissions.…”

Section: Discussionmentioning

confidence: 99%

“…Given the favorable outcomes and technical improvements, multiple groups have assessed the feasibility of performing HoLEP as an ambulatory procedure. Larner et al [13] first described this approach in 2003 and additional studies have been performed more recently [14][15][16][17][18]. There has been varied success, with same-day discharge (SDD) rates of 35.3-97.3% [14,16].…”

Section: Introductionmentioning

confidence: 99%

Same Day Discharge is a Successful Approach for the Majority of Patients Undergoing Holmium Laser Enucleation of the Prostate

Agarwal

Large

Tong

et al. 2022

European Urology Focus

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The outcomes of same-day discharge following holmium laser enucleation of the prostate (HoLEP) surgeries: our experience during the COVID-19 pandemic

Badreddine¹,

Sun²,

Tay³

et al. 2023

World J Urol

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Objective To describe the outcomes of Same-Day Discharge (SDD) following Holmium Laser Enucleation of the Prostate (HoLEP) in patients during the COVID-19 pandemic. Methods A retrospective review of HoLEP surgeries at a single institution between January 2021 and March 2022 was performed. Patient demographic and operative data were collected, and postoperative outcomes were evaluated in terms of safety and efficacy and compared in both groups using a t -test and chi-square test. Logistic regression was also performed to identify factors that correlate with the failure of SDD. Results A total of 155 patients were identified; 135 patients were successfully discharged on the same day and 20 were admitted (87% SDD rate). Admitted HoLEP patients had a significantly higher median prostate-specific antigen (5.7 vs 3.9 ng/dL, P < 0.001), prostate volume (152.3 vs 100.6 mL, P < 0.001), and enucleated tissue weight (90.3 vs 56.9 g, P = 0.04) compared to the SDD group. The SDD group had a 2.9% ( n = 4) readmission rate and a 5.2% ( n = 7) Emergency Department (ED) visit rate. There was no significant difference in the rate of postoperative ED visits ( P = 0.64), readmissions ( P = 0.98), complications, and catheterization time ( P = 0.98) between both groups. Preoperative predictors of SDD failure included prostate gland volume > 150 mL (OR = 7.17; CI 2.01–25.67; P < 0.01) and history of antiplatelet/anticoagulation use (OR = 6.59; CI 2.00–21.67; P < 0.01). Conclusion Same-day discharge following HoLEP is a safe and effective approach that can be performed in most patients using a liberal discharge criteria and relying on postoperative findings only.

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Holmium Laser Enucleation of the Prostate Is Safe and Feasible as a Same Day Surgery

Cited by 37 publications

References 18 publications

Catheter Removal on the Same Day of Holmium Laser Enucleation of the Prostate: Outcomes of a Pilot Study

Catheter Removal on the Same Day of Holmium Laser Enucleation of the Prostate: Outcomes of a Pilot Study

Same Day Discharge is a Successful Approach for the Majority of Patients Undergoing Holmium Laser Enucleation of the Prostate

The outcomes of same-day discharge following holmium laser enucleation of the prostate (HoLEP) surgeries: our experience during the COVID-19 pandemic

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