Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Department of Urology, Northwestern University, Chicago, Illinois, USA.
J Endourol. 2021 Sep;35(9):1386-1392. doi: 10.1089/end.2020.1218. Epub 2021 Mar 17.
Holmium laser enucleation of the prostate (HoLEP) is a highly effective and durable minimally invasive surgery for benign prostatic hyperplasia. Historically, alternative treatments for large glands (≥175 cc) are associated with prolonged length of stay (LOS) and postoperative catheterization. However, advances in laser technology combined with surgical technique optimization have early evidence supporting same-day discharge. We look to examine contemporary same-day discharge outcomes for large glands. With Institutional Review Board (IRB) approval we queried our electronic medical record and retrospective clinical registry to examine perioperative outcomes of large gland (≥175 cc) prostates that underwent HoLEP with consideration for same-day discharge. From December 10, 2019 to September 29, 2020 we identified 55 patients with a preoperative prostate size ≥175 cc (39 CT, 12 MRI, 4 transrectal ultrasound), of which 45 were scheduled for same-day discharge and 10 for admission. Mean preoperative prostate size was 229.9 cc (range 175-535 cc) and 36 (65.5%) were in urinary retention. Mean preoperative prostate-specific antigen (PSA) was 8.58 ng/mL, American Urological Association Symptom Score (AUASS) 22.3, and Qmax 8.8 mL/second. At 3 months postoperative follow-up mean AUASS was 6.7, PSA 0.87 ng/mL and Qmax 20.4 mL/second. All comer same-day discharge rate was 70% (38/55). Of patients planned for same-day discharge 38/45 (84%) were effective. Average LOS for all patients was 11.8 hours with catheterization of 21.2 hours. When compared with 2010 published large gland outcomes, our current LOS represents a 220% reduction. Looking specifically at patients planned for same-day discharge, average LOS and catheter duration was 8.8 and 17.0 hours, whereas LOS and catheter duration for patients planned for admission was 25.7 and 39.4 hours, respectively. We report the first outcomes of preoperatively planned same-day discharge for HoLEP in large glands (≥175 cc). A combination of technologic advances and optimization of technique have allowed for a safe adoption of same-day discharge, providing additional advantages over alternative large gland treatments.
钬激光前列腺剜除术（HoLEP）是一种治疗良性前列腺增生症的高效、持久的微创治疗方法。历史上，对于大腺体（≥175cc）的替代治疗与住院时间延长（LOS）和术后导尿有关。然而，激光技术的进步与手术技术的优化相结合，有早期证据支持当天出院。我们研究了大腺体（≥175cc）HoLEP 患者的当代当天出院结果。我们获得机构审查委员会（IRB）的批准，通过电子病历和回顾性临床登记处，研究了接受 HoLEP 治疗并考虑当天出院的大腺体（≥175cc）前列腺的围手术期结果。从 2019 年 12 月 10 日至 2020 年 9 月 29 日，我们确定了 55 名术前前列腺大小≥175cc（39 名 CT，12 名 MRI，4 名经直肠超声）的患者，其中 45 名计划当天出院，10 名入院。术前前列腺平均大小为 229.9cc（范围 175-535cc），36 名（65.5%）有尿潴留。术前前列腺特异性抗原（PSA）平均为 8.58ng/ml，美国泌尿外科学会症状评分（AUASS）为 22.3，最大尿流率（Qmax）为 8.8ml/秒。术后 3 个月随访时，平均 AUASS 为 6.7，PSA 为 0.87ng/ml，Qmax 为 20.4ml/秒。所有接受当天出院的患者比例为 70%（38/55）。计划当天出院的患者中，38/45（84%）有效。所有患者的平均 LOS 为 11.8 小时，导尿时间为 21.2 小时。与 2010 年发表的大腺体结果相比，我们目前的 LOS 减少了 220%。具体来看，计划当天出院的患者的平均 LOS 和导尿时间分别为 8.8 小时和 17.0 小时，而计划入院的患者的 LOS 和导尿时间分别为 25.7 小时和 39.4 小时。我们报告了 HoLEP 在大腺体（≥175cc）中术前计划当天出院的第一批结果。技术进步的结合和技术优化使当天出院的安全应用成为可能，与其他大腺体治疗方法相比具有额外的优势。
