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

Lee, SM; Gordon, Karen A.; McMillan, Robert L.; Crystal, F; Acher, Peter

doi:10.1308/rcsann.2018.0039

Cited by 28 publications

(38 citation statements)

References 14 publications

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“…We also demonstrate that ASA score alone does not preclude SDD and may not be an effective way of selecting patients for this approach, which was the strategy in prior studies [13,17,18]. Our readmission rate of 1.5% is lower than previously reported, with only 0.6% being secondary to HoLEP itself [16][17][18]. Our results also differ regarding an increase in complications in inpatient groups compared to SDD, but are congruent with no difference in long-term voiding outcomes [18].…”

Section: Discussionsupporting

confidence: 63%

“…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%

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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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Section: Discussionsupporting

confidence: 63%

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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“…Technical progress and new laser technology have reduced morbidity and hospital stay associated with HoLEP. 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.…”

Section: Discussionmentioning

confidence: 99%

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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“…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.…”

Section: Cumulative Fr Of Outpatient Bph Surgical Managementmentioning

confidence: 99%

“…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).…”

Section: Cumulative Fr Of Outpatient Bph Surgical Managementmentioning

confidence: 99%

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

Salciccia

Giudice

Maggi

et al. 2021

Journal of Endourology

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Purpose: Most of the endourologic procedures along the urinary tract have been widely practiced as outpatient operations, including surgery for benign prostatic hyperplasia (BPH). This systematic review and meta-analysis was conducted to assess safety and feasibility of outpatient surgery for patients suffering from symptomatic BPH candidate for endoscopic disobstruction. Materials and Methods: PubMed, Web of Science, Cochrane, and Embase were searched up until March 30, 2020. Methodological index for nonrandomized studies (MINORS) tool was utilized to assess the quality of included studies, and a pooled measure of failure rate (FR) or event rate (ER) estimate was calculated. Further sensitivity analysis, subgroup analysis, and meta-regression were conducted to investigate contribution of moderators to heterogeneity. Results: Twenty studies with a total of 1626 patients treated according to outpatient criteria for endoscopic BPH surgery were included. In total, 18 studies reporting data on immediate hospital readmission and/or inability to discharge after endoscopic procedure presented FR estimates ranging from 1.7% to 51.1%. Pooled FR estimate was 7.8% (95% confidence interval [CI]: 5.2-10.3); Heterogeneity: Q = 76.85; degree of freedom = 17, p < 0.001; I 2 = 75.12%. Subgroup analysis according to surgical technique revealed difference among the three approaches with pooled FR of 3% (95% CI: 1-4.9), 7.1% (95% CI: 3.9-10.4), and 11.8% (95% CI: 7-16.7) for transurethral resection of the prostate, Green-light, and holmium laser vaporesection, respectively (p < 0.001). At meta-regression analysis, none of the retrieved covariates was able to significantly influence the cumulative outcomes reported. ER for postoperative complications and early outpatient visit showed a pooled estimate of 18.6% (95% CI: 13.2-23.9) and 7.7% (95% CI: 4.3-11), respectively. Conclusions: Our analysis revealed how transurethral procedures for BPH on an outpatient setting are overall reliable and safe. Of note, there were significant outcome differences between groups with regard to type of surgical procedure, perioperative prostate volume, and discharge protocol suggesting the need for further prospective analysis to better elucidate the best strategy in such outpatient conduct.

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

Cited by 28 publications

References 14 publications

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

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

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

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

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