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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Abstract

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.

Related collections

Most cited references 21

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Impact of the Coronavirus (COVID-19) pandemic on surgical practice - Part 1 (Review Article)

Ahmed Al-Jabir, Ahmed Kerwan, Maria R.C. Nicola … (2020)

The Coronavirus (COVID-19) pandemic has resulted in over 2.3 million confirmed cases and over 160,000 deaths. The impact of COVID-19 on surgical practice is widespread ranging from workforce and staffing issues, procedural prioritisation, viral transmission risk intraoperatively, changes to perioperative practice and ways of working alongside the impact on surgical education and training. Whilst there has been a growing literature base describing the early clinical course of COVID-19 and on aspects of critical care related to treating these patients, there has been a dearth of evidence on how this pandemic will affect surgical practice. This paper seeks to review the current evidence and offers recommendations for changes to surgical practice to minimise the effect of the COVID-19 pandemic.

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Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature.

Hemendra N Shah, Amol P Mahajan, Sunil S Hegde … (2007)

To evaluate, in a prospective study, the complications in 280 patients undergoing holmium laser enucleation of the prostate (HoLEP) at our institution, and to review previous reports to determine the overall incidence and types of various complications, and analyse their causes and means of prevention. We analysed the patients' demographic, peri-operative and follow-up data, and the complications during and after surgery. HoLEP was completed successfully in 268 patients (95.7%); eight required conversion to transurethral resection of the prostate (TURP) during the initial experience. The morcellation device and laser malfunctioned in two patients each. A blood transfusion was required during HoLEP in one patient; other complications included capsular perforation (9.6%), superficial bladder mucosal injury (3.9%) and ureteric orifice injury (2.1%). A blood transfusion was needed after HoLEP in 1.4% of patients and cystoscopy with clot evacuation in 0.7%. Transient urinary incontinence was the commonest complication after HoLEP, in 10.7% of patients, but recovered spontaneously in all except two (0.7%). Other rare complications were re-catheterization (3.9%), urinary tract infection (3.2%), epididymitis (0.7%), meatal and submeatal stenosis (2.5%), bulbar urethral stricture (2.1%), bladder neck contracture (0.35%) and myocardial infarction (0.35%). There was a low incidence of complications with HoLEP; most were minor and easily managed. Our results are comparable with those published previously, and establish HoLEP as safe and reproducible procedure. While gaining experience, HoLEP can be converted to TURP with no harm to the patient.

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Three-year outcome following holmium laser enucleation of the prostate combined with mechanical morcellation in 330 consecutive patients.

Ivano Vavassori, Sergio Valenti, Richard Naspro … (2008)

A prospective study to assess safety, efficacy, and medium-term durability of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation for the treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Between January 2000 and July 2003, 330 consecutive patients underwent HoLEP at our institution. All patients were pre-operatively assessed with transrectal ultrasound gland volume evaluation, maximum urinary flow rate (Q(max)), international prostate symptoms score (IPSS), and the single-question quality of life (QoL). Intra-, peri-, and postoperative parameters were evaluated and the patients were reassessed at 1-, 3-, 6-, 12-, 18-, 24-, and 36-mo follow-up with the same examinations. Patients' mean age was 66+/-8.1 yr; prostate volume was 62+/-34 cc. Enucleation time was 45.4+/-22.9 min and morcellation time 17.3+/-14 min, whilst resected weight was 40+/-27.5 g. Catheter time was 23+/-14.7h and hospital stay was 48+/-26 h. Mean serum hemoglobin and sodium did not drop significantly from baseline after the procedure (p=013). A significant improvement occurred in Q(max) (25.1+/-10.7 ml/s), IPSS (0.7+/-1.3), and QoL (0.2+/-0.5) at the 3-yr follow-up compared with baseline (p<0.05). Twenty-eight percent of patients complained of irritative urinary symptoms, typically self-limiting after 3 mo; transient stress incontinence was reported in 7.3% of patients. Nine patients (2.7%) had persistent BOO, requiring reoperation. HoLEP represents an effective and safe surgical intervention. The relief from BOO also proved to be durable after 3-yr follow-up. The present report adds to the evidence that HoLEP could be the standard "size-independent" surgical treatment for symptomatic BPE-related BOO.

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Author and article information

Contributors

Jad Badreddine: Jad.Badreddine@UHhospitals.org

Helen Sun: Helen.Sun2@UHhospitals.org

Kimberly Tay: Kimberly.Tay@UHhospitals.org

Stephen Rhodes: Stephen.Rhodes@UHhospitals.org

Daniel Chen: Daniel.Chen@UHhospitals.org

Michael Zell: Michael.Zell@UHhospitals.org

Irina Jaeger: Irina.Jaeger@UHhospitals.org

Amihay Nevo: Amihaynevo@gmail.com

Journal

Journal ID (nlm-ta): World J Urol

Journal ID (iso-abbrev): World J Urol

Title: World Journal of Urology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0724-4983

ISSN (Electronic): 1433-8726

Publication date (Electronic): 9 May 2023

Pages: 1-7

Affiliations

[1 ]GRID grid.443867.a, ISNI 0000 0000 9149 4843, Urology Institute, , University Hospitals Cleveland Medical Center, ; Cleveland, OH USA

[2 ]GRID grid.67105.35, ISNI 0000 0001 2164 3847, Case Western Reserve University School of Medicine, ; Cleveland, OH USA

[3 ]GRID grid.12136.37, ISNI 0000 0004 1937 0546, Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, , Tel-Aviv University, ; Tel-Aviv, Israel

Article

Publisher ID: 4410

DOI: 10.1007/s00345-023-04410-2

PMC ID: 10169120

PubMed ID: 37160451

SO-VID: 337a7bd0-d081-429a-bad4-0f00cb88192b

Copyright © © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

History

Date received : 7 February 2023

Date accepted : 11 April 2023

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