WCE 2019: Safety of Holmium Laser Enucleation of the Prostate in the Outpatient Setting

Abu Dhabi, United Arab Emirates (UroToday.com) Traditionally, holmium laser enucleation of the prostate (HoLEP) required an overnight hospital stay with continuous bladder irrigation. Deepak Agarwal, an endourology fellow at Indiana University, presents their single surgeon experience of holmium laser enucleation of the prostate (HoLEP) in an outpatient setting. Cases between July 2017 and March 2018 were retrospectively reviewed, assessing preoperative, perioperative, and postoperative parameters. 52 patients underwent HoLEP with intention of same-day discharge. The average of the cohort was 69 years with an average prostate size of 59g. 54% of patients had hypertension, 23% with cardiac arrhythmias,19% had a history of coronary artery disease, and 21% had diabetes mellitus, type 2. The intraoperative parameters included median enucleated tissue of 36g, median enucleation time of 59 minutes, median morcellation time of 4 minutes, median postoperative CBI time of 212 minutes (173-353 minutes), and a median time to discharge of 316 minutes (243-414 minutes).

Based on their established hematuria/urine clarity protocol, 90% of patients were able to be discharged home the day of surgery. 5 patients required overnight observation and were discharged the following day. They compared age, prostate volume, retention rate, enucleated tissue, and enucleation time between patients discharged on the same day and patients requiring overnight observation. There were no statistically significant differences. At a 3-month follow-up, there was a statistically significant improvement in AUA symptom score, QoL score, Qmax, and PVR compared to baseline.

In conclusion, 10% of patients required overnight observation for continued bladder irrigation according to their hematuria protocol. Of the patients requiring observation, the maximum stay was 1 day. The authors concluded that HoLEP performed as an outpatient surgery is safe and feasible in selected patients.

Presented by: Deepak K. Agarwal, MD, Endourology Fellow, Indiana University, Mayo Clinic, Rochester, Minnesota

Written by: Pengbo Jiang, MD, Department of Urology, University of California, Irvine at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates