Department of Urology, Indiana University, Indianapolis, Indiana, USA.
J Endourol. 2022 Jul;36(7):977-981. doi: 10.1089/end.2022.0007. Epub 2022 Jun 21.
Holmium laser enucleation of the prostate (HoLEP) is a highly effective treatment of benign prostatic hyperplasia (BPH). Technical advances and improved hemostatic properties of holmium lasers have allowed for increased efficiency and outcomes. Same day catheter removal after HoLEP was described at our institution in 2020 after a 30-patient pilot trial. We now present an expanded update after widespread adoption at our facility. We reviewed patients who underwent same day catheter removal after HoLEP between January 1, 2020 and March 21, 2021. Unlike previous trials, there were no limitations to prostate size. Other changes included catheter removal in phase two of recovery when nursing was available rather than the urology clinic. Descriptive statistics are presented of preoperative, operative, and postoperative data. Univariate and multivariate analysis was performed to assess associations with failure of same day void trial. The success rate of same day catheter removal for the 114 identified patients was 87.7%. Mean age was 69.1 ± 8.6 years and prostate volume was 109.2 ± 61.5 cc, 35% were dependent on catheterization for urinary retention preoperatively and 9% were on antiplatelet/anticoagulant therapy. A total of 26.5% of patients with American Society of Anesthesiology score (ASA) 3 or 4 failed catheter removal compared with 3.9% of patients with ASA 1 or 2 (likelihood ratio 9.32, = 0.002), ASA status lost significance on multivariate analysis ( = 0.076). Effective catheter removal was not significantly associated with age, body mass index, prostate size, catheter dependency, anticoagulation/antiplatelet therapy, American Urologic Association symptom score, prior BPH surgery, or prostate cancer in final pathology report. Regardless of prostate size, same day catheter removal is a safe and reliable method of post-HoLEP patient management. Patients with an ASA 3 or 4 should be counseled regarding potential risks of temporary re-catheterization. Given ongoing nationwide shortages in hospital beds and staffing, same day discharge and catheter removal may allow for wider availability of surgical treatment for BPH.
钬激光前列腺剜除术（HoLEP）是治疗良性前列腺增生（BPH）的有效方法。钬激光技术的进步和更好的止血性能提高了手术效率和效果。在我们机构的 30 例患者试点试验之后，2020 年我们开始报道 HoLEP 术后当天即可拔除导尿管。目前，我们在该机构广泛应用该技术后，对其进行了扩展更新。我们回顾了 2020 年 1 月 1 日至 2021 年 3 月 21 日期间接受 HoLEP 术后当天拔除导尿管的患者。与之前的试验不同，本研究对前列腺体积没有限制。其他变化包括将导尿管拔除时间从泌尿科门诊改为护理人员可提供服务的恢复阶段 2。我们对术前、术中和术后数据进行了描述性统计分析。采用单变量和多变量分析评估与当天排尿试验失败的相关性。114 例患者中，当天拔除导尿管的成功率为 87.7%。平均年龄为 69.1±8.6 岁，前列腺体积为 109.2±61.5cc，35%的患者术前因尿潴留需要留置导尿管，9%的患者正在服用抗血小板/抗凝药物。美国麻醉医师学会（ASA）评分 3 或 4 级的患者中，有 26.5%的患者拔除导尿管失败，而 ASA 评分 1 或 2 级的患者中，只有 3.9%的患者拔除导尿管失败（比值比 9.32，=0.002），ASA 状态在多变量分析中失去意义（=0.076）。有效导尿管拔除与年龄、体重指数、前列腺体积、导尿管依赖、抗凝/抗血小板治疗、美国泌尿外科学会症状评分、既往 BPH 手术或前列腺癌最终病理报告均无显著相关性。无论前列腺体积大小，HoLEP 术后当天拔除导尿管是一种安全可靠的患者管理方法。ASA 评分 3 或 4 级的患者应告知其潜在的临时重新置管风险。考虑到全国范围内医院床位和人员短缺，当天出院和导尿管拔除可能会使更多的 BPH 患者接受手术治疗。
