The Utilization and Safety of Same-Day Discharge After Transurethral Benign Prostatic Hyperplasia Surgery: A Case-Control, Matched Analysis of a National Cohort

Garden, Evan; Ravivarapu, Krishna T.; Levy, Micah; Chin, Chih Peng; Omidele, Olamide; Tomer, Nir; Al-Alao, Osama; Araya, Joseph Sewell; Small, Alexander; Palese, Michael

doi:10.1016/j.urology.2022.01.037

Cited by 13 publications

(3 citation statements)

References 28 publications

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“…Although NSQIP is a high-quality database drawing data from trained institutional reporters, this study has limitations [28,29]. Foremost, its retrospective nature limits interpretation.…”

Section: Discussionmentioning

confidence: 99%

Patient Factors Impacting Perioperative Outcomes for T1b-T2 Localized Renal Cell Carcinoma May Guide Decision for Partial versus Radical Nephrectomy

Shah

Simhal

Wang

et al. 2022

JCM

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There remains debate surrounding partial (PN) versus radical nephrectomy (RN) for T1b-T2 renal cell carcinoma (RCC). PN offers nephron-sparing benefits but involves increased perioperative complications. RN putatively maximizes oncologic benefit with complex tumors. We analyzed newly available nephrectomy-specific NSQIP data to elucidate predictors of perioperative outcomes in localized T1b-T2 RCC. We identified 2094 patients undergoing nephrectomy between 2019–2020. Captured variables include surgical procedure and approach, staging, comorbidities, prophylaxis, peri-operative complications, reoperations, and readmissions. 816 patients received PN while 1278 received RN. Reoperation rates were comparable; however, PN patients more commonly experienced 30-day readmissions (7.0% vs. 4.7%, p = 0.026), bleeds (9.19% vs. 5.56%, p = 0.001), renal failure requiring dialysis (1.23% vs. 0.31%, p = 0.013) and urine leak or fistulae (1.10% vs. 0.31%, p = 0.025). Infectious, pulmonary, cardiac, and venothromboembolic event rates were comparable. Robotic surgery reduced occurrence of various complications, readmissions, and reoperations. PN remained predictive of all four complications upon multivariable adjustment. Several comorbidities were predictive of complications including bleeds and readmissions. This population-based cohort explicates perioperative outcomes following nephrectomy for pT1b-T2 RCC. Significant associations between PN, patient-specific factors, and complications were identified. Risk stratification may inform management to improve post-operative quality of life (QOL) and RCC outcomes.

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“…Although NSQIP is a high-quality database drawing data from trained institutional reporters, this study has limitations [28,29]. Foremost, its retrospective nature limits interpretation.…”

Section: Discussionmentioning

confidence: 99%

Patient Factors Impacting Perioperative Outcomes for T1b-T2 Localized Renal Cell Carcinoma May Guide Decision for Partial versus Radical Nephrectomy

Shah

Simhal

Wang

et al. 2022

JCM

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“…However, further cost effectiveness analysis should also take possible complications and especially reoperation rate into consideration [4]. All in all, same-day discharge after surgical treatment for BPO is probably becoming increasingly popular for selected patients, considering the publication of further studies of the safety of such an approach [29]. The mean age of all operated patients increased by 2 years to 71.8 at the end of the study period.…”

Section: Discussionmentioning

confidence: 99%

National trends of surgery for benign prostatic hyperplasia in Finland

Salmivalli,

Boström,

Nurminen

et al. 2024

SJU

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Purpose: To investigate national trends of surgical treatment for benign prostatic obstruction (BPO). Methods: The Care Register for Healthcare in Finland was used to investigate the annual numbers and types of surgical procedures, operation incidence and duration of hospital stay between 2004 and 2018 in Finland. Procedures were classified using the Nordic Medico-Statistical Committee Classification of Surgical Procedures coding. Trends in incidence were analyzed with two-sided Cochran-Armitage test. Trends in duration of hospital stay and patient age were analyzed with linear regression. Results: Transurethral resection of the prostate (TURP) was the most common operation type during the study period, covering over 70% of operations for BPO. Simultaneous with the implementation of photoselective vaporization of the prostate (PVP), the incidence of TURP, minimally invasive surgical therapies, transurethral vaporization of the prostate (TUVP) and open prostatectomies decreased (p < 0.05). The mean operation incidence rate in the population between 2004 and 2018 was 263 per 100,000. The duration of hospital stay shortened (p < 0.05), and the average age of operated patients increased by 2 years (p < 0.0001). Conclusion: The implementation of PVP did not challenge the dominating position of TURP in Finland, but it has probably influenced the overall use of other surgical therapies, excluding transurethral incision of the prostate. The results might suggest that the conservative treatment is accentuated, patient selection is more thorough, and surgical intervention might be placed at a later stage of BPO.

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“…Meanwhile, the prostatic fossa wound may be bloodless after the surgery. Related studies have also shown that the time required after bladder irrigation is decreasing, and in some cases, daytime surgery has been implemented for BPH surgery [9][10][11][12]. Therefore, the time of continuous bladder irrigation postoperative has been decreasing and it may not be considered an essential step after HoLEP for BPH surgery.…”

Section: Introductionmentioning

confidence: 99%

No bladder irrigation versus continuous bladder irrigation after HoLEP: a propensity score matching analysis

et al. 2023

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Purpose In this study, the feasibility of a no bladder irrigation strategy after transurethral holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH) was studied. Methods From August 2021 to December 2021, the clinical data of 62 patients who received no bladder irrigation after HoLEP (Group A) were studied. The control group contained the clinical data of 150 patients in the same therapy group (from January 2021 to July 2021) who received continuous bladder irrigation after HoLEP (Group B). The baseline was consistent after using the propensity score matching (PSM) method, and the differences between groups were compared. The pre- and postoperative complications, international prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR) of the two groups were compared, accompanied by a follow-up evaluation of surgical effects. Results 47 pairs of patients were successfully matched by PSM. There was no statistically significant difference in the intraoperative conditions and the incidence of early postoperative complications between the two groups (P > 0.05). Before and one month after the surgery, significant differences were also found in the IPSS, QOL, Qmax, and PVR of both groups (P < 0.05). Within one month after the surgery, no statistically significant difference was found in IPSS, QOL, Qmax, PVR, or the incidence of early postoperative complications between the two groups (P > 0.05). Conclusion For appropriately selected patients according to the exclusion criteria, the no bladder irrigation strategy after HoLEP for BPH is safe and effective.

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The Utilization and Safety of Same-Day Discharge After Transurethral Benign Prostatic Hyperplasia Surgery: A Case-Control, Matched Analysis of a National Cohort

Cited by 13 publications

References 28 publications

Patient Factors Impacting Perioperative Outcomes for T1b-T2 Localized Renal Cell Carcinoma May Guide Decision for Partial versus Radical Nephrectomy

Patient Factors Impacting Perioperative Outcomes for T1b-T2 Localized Renal Cell Carcinoma May Guide Decision for Partial versus Radical Nephrectomy

National trends of surgery for benign prostatic hyperplasia in Finland

No bladder irrigation versus continuous bladder irrigation after HoLEP: a propensity score matching analysis

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