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Xu P, Dean NS, Tsai K, Ganesh M, Khondakar N, Guo JN, Krambeck AE. To Hold or Continue Blood Thinners? A Retrospective Analysis on Outcomes of Holmium Laser Enucleation of the Prostate (HoLEP) in Patients who Either Held or Continued Antiplatelet/Anticoagulation Therapy. Urology 2024:S0090-4295(24)00741-6. [PMID: 39214500 DOI: 10.1016/j.urology.2024.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/13/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES To compare the outcomes between those who held or continued APAC (antiplatelet or anticoagulation therapy) for HoLEP (holmium laser enucleation of the prostate). METHODS We retrospectively reviewed patients on APAC who underwent HoLEP between January 2021 and August 2023 by a single surgeon at a high-volume center. APAC was further categorized to the specific medication: clopidogrel, apixaban, warfarin, rivaroxaban. Preoperative, intraoperative, and postoperative characteristics and outcomes were then compared. SPSS was used for statistical analysis with significance defined as p<0.05. RESULTS 139 patients were on APAC, of which 82 held and 57 continued APAC: 38 on clopidogrel (21 held), 20 on warfarin (11 held), 57 on apixaban (34 held), 24 on rivaroxaban (16 held). Overall, there were no significant differences between those who held versus those who continued APAC. On sub-analysis, controlling for age and prostate size, patients who held clopidogrel had shorter length of stays (11.3hr vs 27.3hr, p=0.016), higher likelihood for same-day catheter removal (90.5% vs 47.1%, p=0.002) and same-day discharge (90.5% vs 35.3%, p=0.002). Patients who held warfarin had shorter procedure (61.3 min vs 92.2min, p = 0.025) and morcellation time (7.36min v 18min, p=0.048). CONCLUSIONS HoLEP is safe and efficacious in patients whether APAC is held or continued through surgery. Holding APAC in those on clopidogrel may decrease length of stay and improve rates of same-day foley removal and discharge. Patients who held warfarin had shorter morcellation and procedure times.
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Affiliation(s)
- Perry Xu
- Northwestern University, Department of Urology, Chicago, IL.
| | - Nicholas S Dean
- Northwestern University, Department of Urology, Chicago, IL.
| | - Kyle Tsai
- Northwestern University, Department of Urology, Chicago, IL.
| | - Meera Ganesh
- Northwestern University, Department of Urology, Chicago, IL.
| | | | - Jenny N Guo
- Northwestern University, Department of Urology, Chicago, IL.
| | - Amy E Krambeck
- Northwestern University, Department of Urology, Chicago, IL.
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Zorn KC, Chakraborty A, Chughtai B, Mehan R, Elterman D, Nguyen DD, Bouhadana D, Glaser AP, Marhamati S, Barber N, Helfand BT. Safety and Efficacy of Same Day Discharge for Men Undergoing Contemporary Robotic-Assisted Aquablation Prostate Surgery in an Ambulatory Surgery Center Setting - First Global Experience. Urology 2024:S0090-4295(24)00658-7. [PMID: 39159759 DOI: 10.1016/j.urology.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVE To investigate the feasibility, safety and efficacy of same day discharge (SDD) after Aquablation specifically in an ambulatory surgery center (ASC). METHODS A prospective cohort of men with significant BPH underwent Aquablation at a single ASC. Comprehensive preoperative assessments were conducted, including uroflowmetry, IPSS, and PVR. Aquablation was performed as morning cases by a single experienced surgeon. Following the procedure, men were assessed for immediate postoperative outcomes, including pain levels, hematuria, and voiding efficiency. Patients meeting discharge criteria were allowed to return home on the same calendar day. RESULTS A total of 60 consecutive men with a mean prostate size of 115ml underwent Aquablation, 59 (98%) of whom were discharged the dame day. No transfusions or return to the OR occurred. The procedure demonstrated a significant improvement in urinary flow rates and a substantial reduction in IPSS scores at the 1-month post-operative period. Pain scores were found to be minimal, and the incidence of postoperative complications, including hematuria and urinary retention was low and comparable to previously published outcomes. Despite more meticulous focal cautery, no differences in erectile, ejaculatory or adverse outcomes were observed. CONCLUSIONS Aquablation for BPH at an ASC appears to be a safe and effective approach. Morning procedures and attentive cautery and streamlined patient pathways seem essential for SDD. Despite electrosurgical hemostasis, ejaculatory, sexual and post-operatively pain were not compromised.
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Affiliation(s)
- Kevin C Zorn
- BPHCanada Prostate Center, Mont-Royal Surgical Center, Montreal, QC, Canada.
| | | | - Bilal Chughtai
- Division of Urology, Northwell Health, Plainview, New York
| | | | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David-Dan Nguyen
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Bouhadana
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Alexander P Glaser
- Endeavor Health (Formerly NorthShore University HealthSystem), Department of Surgery, Division of Urology, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Department of Surgery, Division of Urology, Chicago, IL, USA
| | | | | | - Brian T Helfand
- Endeavor Health (Formerly NorthShore University HealthSystem), Department of Surgery, Division of Urology, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Department of Surgery, Division of Urology, Chicago, IL, USA
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Carvalho BRG, Gabrich PN, de Marins RL, Damião R, Oliveira RV. Same-day Catheter Removal and Hospital Discharge After Holmium Laser Enucleation of the Prostate: A Prospective Study. Urology 2024; 190:78-82. [PMID: 38871305 DOI: 10.1016/j.urology.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/21/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To assess the feasibility, safety, and predictive factors for the success of holmium laser enucleation of the prostate (HoLEP) with catheter removal and hospital discharge on the same day of the procedure. METHODS This prospective study included 34 patients who underwent HoLEP using a 60-W holmium laser device and the Wolf Piranha morcellation system. Surgeries began at 10:30 am and the patients were expected to be discharged by 5 pm on the same day. The patients underwent a voiding trial to remove the urinary catheter before hospital discharge. Functional outcomes were assessed 90 days after the procedure. RESULTS Mean (range) age, prostate-specific antigen value, and prostate weight were as follows: 63.4 (50-80) years, 4.81 (0.19-14) ng/mL, and 89.3 (33-258) g, respectively. The mean (range) enucleation and morcellation times were 56.2 (29-91) minutes and 14.67 (3-45) minutes, respectively. Thirty-one patients (91.1%) were discharged on the same day of the procedure after urinary catheter removal. CONCLUSION The performance of HoLEP is safe on an outpatient basis. Same-day catheter removal is feasible and does not affect hospital discharge.
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Affiliation(s)
| | | | | | - Ronaldo Damião
- University of the State of Rio de Janeiro, Rio de Janeiro
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Wenk MJ, Hartung FO, Egen L, Netsch C, Kosiba M, Grüne B, Herrmann J. The long-term learning curve of holmium laser enucleation of the prostate (HoLEP) in the en-bloc technique: a single surgeon series of 500 consecutive cases. World J Urol 2024; 42:436. [PMID: 39046537 PMCID: PMC11269500 DOI: 10.1007/s00345-024-05097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/29/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) of a single surgeon in 500 consecutive cases. METHODS Demographic parameters, outcomes, and adverse events were evaluated. The learning curve for HoLEP in en-bloc technique of the first 500 consecutive patients was analyzed in clusters of 100 (clusters 1-5) using the Wilcoxen rank test, Chi² test and Kruskal Wallis test. RESULTS Enucleation weight was similar in the clusters 1,2,3, and 5 (62 g, 63 g, 61 g, 61 g), in cluster 4 it was slightly higher at 73 g. There was a significant reduction in operating time from 67 min (cluster 1) to 57 min (cluster 2), 46 min (cluster 3), 53 min (cluster 4), and 43 min (cluster 5), p < 0.001. Enucleation efficiency (g/min) showed a steady increase (1.72, 2.24, 2.79, 2.92 vs. 2.99, p < 0.001). Laser energy efficiency also improved (2.17 vs. 2.12 vs. 1.71 vs. 1.65 vs. 1.55; p < 0.001). There was no measurable learning curve regarding the length of hospital stay (mean 2.5 days), catheterization time (1.9 days), hemoglobin drop (approx. 1 g/dl) or complications (p > 0.1). CONCLUSIONS HoLEP using the en-bloc technique is a safe and highly effective method. Over time, a slight but steady learning curve and improvement in operation time, enucleation efficiency and laser energy efficiency were shown even for an experienced surgeon - after 500 cases, still no plateau was reached. There was no measurable learning curve regarding blood loss, complications, length of hospital stay, and catheterization time.
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Affiliation(s)
- M J Wenk
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - F O Hartung
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - L Egen
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - M Kosiba
- Department of Urology, University Hospital Frankfurt, Frankfurt Main, Germany
| | - B Grüne
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Chavali JSS, Rivera ME, Lingeman JE. HoLEP Learning Curve-Resident Perspective: Survey of Senior Residents from High-Volume Tertiary Center. J Endourol 2024. [PMID: 38904168 DOI: 10.1089/end.2024.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
Objective: We aim to report the learning curve and experience performing holmium laser enucleation of the prostate (HoLEP) from a resident standpoint trained at a tertiary high-volume center. Methods: An electronic survey was distributed to 10 surveyees that included recently graduated chief residents trained at Indiana University in the past 3 years i.e., between 2020 and 2022 with a 100% response rate. The questionnaire focused on HoLEP training experience based on a recently established mentorship curriculum in training the residents through each individual step of the surgery. Results: The average learning curve for performing HoLEP was reported to be greater than 25 cases with 50% of the residents reporting >50 cases to master the technique. The surgical difficulty of steps of the HoLEP were rated on a subjective scale of 1-5: 1 = very easy, 2 = easy, 3 = neutral, 4 = hard, and 5 = very hard. The common challenging steps in decreasing the order of difficulty as reported are performing apical enucleation, joining anterior and posterior planes, and dividing anterior commissure with a mean rating of 3.5, 3.1, and 3.1, respectively. The most difficult aspect of the surgery to master was performing apical dissection (60%). Comparing operative parameters for HoLEP with transurethral resection of the prostate in aspects of resection volume and times, 70% of candidates reported it better for HoLEP whereas 20% had similar times for both procedures. A total of 90% of the residents felt confident to offer HoLEP as part of their practice without the need for any further training. Regarding the initial challenge of including HoLEP surgery in practice, the majority (60%) reported difficulty with equipment set up in their practice while 20% reported difficulty maintaining efficient operating room (OR) times and turnover. Conclusion: We believe HoLEP can be performed immediately after residency training and incorporated into practice with high volume, repeated exposure to HoLEP surgery throughout residency based on study results. The average learning curve reported for performing HoLEP was greater than 25 cases.
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Affiliation(s)
- Jaya Sai S Chavali
- Cleveland Clinic, Cleveland, Ohio, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - James E Lingeman
- Indiana University School of Medicine, Indianapolis, Indiana, USA
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Sherryn S, Tong Z, Xia S, Sun J. Reply to Editorial Comment on "MOSES™ Technology vs Non-Moses Holmium Laser Enucleation of the Prostate: A Randomized Controlled Trial From a High-Volume Center". Urology 2024; 189:79. [PMID: 38677372 DOI: 10.1016/j.urology.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Sherryn Sherryn
- Department of Clinical Medicine, Republic of Indonesia Defense University, Bogor, Indonesia
| | - Zhen Tong
- Department of Urology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Shengqiang Xia
- Department of Urology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Jie Sun
- Department of Urology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China.
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Xu P, Krambeck A. Editorial Comment on "MOSES™ Technology vs Non-Moses Holmium Laser Enucleation of the Prostate: A Randomized Controlled Trial From a High-Volume Center". Urology 2024; 189:77-78. [PMID: 38692494 DOI: 10.1016/j.urology.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Perry Xu
- Northwestern Memorial Hospital, Chicago, IL.
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Dean NS, Lee MS, Assmus MA, Guo J, Xu P, McDonald A, Fadl-Alla A, Helin J, Krambeck AE. Does Resectoscope Sheath Size Influence Holmium Laser Enucleation of the Prostate Outcomes? A Prospective Randomized Controlled Trial. J Endourol 2023; 37:1261-1269. [PMID: 37786336 DOI: 10.1089/end.2023.0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Introduction: Holmium laser enucleation of the prostate (HoLEP) is routinely performed with a 24F, 26F, or a 28F scope. Proponents of the larger scopes propose that a bigger sheath size allows for superior flow and visibility leading to a more efficient operation and better hemostasis. Those utilizing the smaller scopes suggest that the smaller sheath is less traumatic, resulting in lower stricture rates and temporary incontinence. We sought to compare outcomes of ambulatory HoLEP using the 24F and 28F laser scope. Materials and Methods: From May 2022 to March 2023, we randomized patients undergoing HoLEP (<200 cm3 in size) 1:1 to either a 24F or 28F scope. The primary outcome was differences in surgical duration between groups (minutes). Secondary outcomes included surgeon scope evaluation and postoperative patient results. Results: There was no difference in patient characteristics in those randomized to 28F (n = 76) vs 24F (n = 76) (p > 0.05) scopes. Procedural duration and efficiencies were not different between groups (all p > 0.05). The 28F scope was associated with improved surgeon-graded irrigation flow and visibility (p < 0.001). Patients treated with the 28F scope were more likely to achieve effective same-day trial of void (SDTOV) (28F 94.3% vs 24F 82.1%, p = 0.048) and have a shorter length of stay (LOS) (28F 7.0 vs 24F 11.9 hours, p = 0.014), however, rates of same-day discharge (SDD) were not statistically different (28F 87.8% vs 24F 78.4%, p = 0.126). There was no difference between the cohorts in rates of 90-day emergency room presentations, re-admissions, complications, or functional ouctomes (p > 0.05). Conclusions: We identified no clear advantage of scope size with regard to intraoperative or postoperative outcomes at 3-month follow-up due to scope size. However, if SDD is part of your postoperative pathway, the 28F scope may shorten LOS and increase rates of effective SDTOV. Clinicaltrials.gov: NCT05308017.
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Affiliation(s)
- Nicholas S Dean
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew S Lee
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Urology, Ohio State University, Columbus, Ohio, USA
| | - Mark A Assmus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Urology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jenny Guo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Perry Xu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alyssa McDonald
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alla Fadl-Alla
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica Helin
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy E Krambeck
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Spinos T, Tatanis V, Liatsikos E, Kallidonis P. Same-day catheter removal after holmium laser enucleation of the prostate (HoLEP): a systematic review. World J Urol 2023; 41:3503-3510. [PMID: 37878061 DOI: 10.1007/s00345-023-04655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
PURPOSE To summarize all existing evidence regarding the feasibility, safety, and efficacy of same-day trial of void and catheter removal after Holmium Laser Enucleation of the Prostate (HoLEP). Although there have been many reports of the safety and efficacy of same-day discharge from the hospital for selected patients undergoing HoLEP, in most of these reports, patients return to the hospital, usually on postoperative day one, to undergo a trial of void and catheter removal. METHODS PubMed®, Scopus®, and Cochrane® primary databases were systematically screened, from inception to 17 January 2023. The search strategy used the PICO (Patient, Intervention, Comparison, Outcomes) Framework. We followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS Six studies met all the predefined criteria and were included in the final qualitative synthesis. Four studies were retrospective and two were prospective. Four studies were non-comparative, while two were comparative ones. The same-day catheter removal success rate ranged from 85.5 to 90% among studies, while only one grade-IIIb Clavien-Dindo complication was reported, which was unrelated to surgery. CONCLUSION Same-day catheter removal is a feasible, safe, and efficient approach for selected patients undergoing HoLEP. Certain factors, such as intraoperative furosemide administration, were found to improve same-day catheter-free rates, while preoperative PVR and urinary retention were independent predictive factors of same-day trial of void failure.
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Affiliation(s)
- Theodoros Spinos
- Department of Urology, University of Patras Hospital, 26504, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University of Patras Hospital, 26504, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Hospital, 26504, Patras, Greece
- Department of Urology, Medical University of Vienna, 1090, Vienna, Austria
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Yilmaz M, Karaaslan M, Polat ME, Tonyali S, Aybal HÇ, Şirin ME, Toprak T, Tunç L, Gratzke C, Miernik A. Is day-case surgery feasible for laser endoscopic enucleation of the prostate? A systematic review. World J Urol 2023; 41:2949-2958. [PMID: 37689604 PMCID: PMC10632304 DOI: 10.1007/s00345-023-04594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023] Open
Abstract
PURPOSE Laser endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction has become increasingly prevalent worldwide. Considering the medical cost-savings and concomitantly fewer nosocomial infections, the feasibility of same-day postoperative discharge of patients who have undergone laser EEP in terms of its safety and effectiveness has become a subject matter of growing interest. We aimed to review those studies focussing on day-case surgery (DCS) in patients undergoing laser EEP. METHODS A systematic search was conducted using PubMed-MEDLINE and Web of Science databases until October 2022 with the following search terms: "same day discharge AND laser enucleation of the prostate", "day-case AND laser enucleation of the prostate", "same day surgery AND laser enucleation of the prostate" and "one day surgery AND laser enucleation of the prostate" by combining PICO (population, intervention, comparison, outcome) terms. We identified 15 eligible studies. RESULTS While 14 of the studies focussed on holmium laser EEP, one focused on thulium laser vapoenucleation of the prostate. We observed an improvement in functional parameters in all studies we reviewed, and DCS success and readmission rates ranged between 35.3-100% and 0-17.8%, respectively. The complication rates varied between 0 and 36.7%, most of the complicatons were Clavien-Dindo (CD) I and II. CD ≥ III complications did not significantly differ between same day discharge (SDD) and non-SDD groups in the studies. CONCLUSION Laser EEP is feasible and promising DCS treatment option delivering improved functional parameters compared to baseline values, and lower perioperative complication and readmission rates in certain patients.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | | | - Muhammed Emin Polat
- Department of Urology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Senol Tonyali
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Urology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | | | - Mehmet Emin Şirin
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Tuncay Toprak
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Lütfi Tunç
- Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey
| | - Christian Gratzke
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Taha T, Savin Z, Lifshitz K, Veredgorn Y, Mendelson T, Bar-Yosef Y, Yossepowitch O, Sofer M. Mini-HoLEP (MILEP) vs HoLEP: a propensity score-matched analysis. World J Urol 2023; 41:2801-2807. [PMID: 37626182 DOI: 10.1007/s00345-023-04562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Minimal invasiveness improves outcome in many surgical fields including urology. We aimed to assess intraoperative performance and clinical outcome of miniaturized holmium laser enucleation of prostate (MiLEP) (22FR). METHODS We ran a propensity score-matched analysis among all consecutive laser enucleations of prostate performed between 9/2022 and 2/2023. It resulted in two matched comparison groups: MiLEP 22 FR (n = 40) and holmium laser enucleation of prostate (HoLEP 26 Fr) (n = 40). Statistical analysis was performed. RESULTS MiLEP was associated with significantly less intraoperative irrigation (20.5 L vs 15 L, p = 0.002E-3), less decrease in body core temperature (0.6°C vs 0.1°C, p = 0.003E-5), and less need for meatal dilation (25% vs 78%, p = 0.01E-3). These parameters were identified as being independent in the multivariate analysis. There was a trend toward less and a shorter period of postoperative stress incontinence (SI) for the MiLEP group compared to the HoLEP group: 15% and 42% (p = 0.01) at 1 month, 8% and 14% (p = 0.07) at 2 months, and 0 and 0.3% (p = 1) at 3 months, respectively. There were no differences in prostatic enucleation effectiveness, operative time, hospital stay, complications, and improvement in the international prostate symptom score and quality of life score. CONCLUSIONS MiLEP is feasible and provides better maintenance of body core temperature, reduction in amount of fluid irrigation, and decrease in need for meatal dilation without affecting effectiveness in comparison with HoLEP. MiLEP may reduce early postoperative stress incontinence, thereby shortening the recovery period.
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Affiliation(s)
- Tarek Taha
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Affiliated to School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Ziv Savin
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Affiliated to School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
- Department of Urology, Tel-Aviv Sourasky Medical Center Ichilov, Tel-Aviv, Israel
| | - Karin Lifshitz
- Affiliated to School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
- Department of Urology, Tel-Aviv Sourasky Medical Center Ichilov, Tel-Aviv, Israel
| | - Yotam Veredgorn
- Affiliated to School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
- Department of Urology, Tel-Aviv Sourasky Medical Center Ichilov, Tel-Aviv, Israel
| | - Tomer Mendelson
- Affiliated to School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
- Department of Urology, Tel-Aviv Sourasky Medical Center Ichilov, Tel-Aviv, Israel
| | - Yuval Bar-Yosef
- Affiliated to School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
- Department of Urology, Tel-Aviv Sourasky Medical Center Ichilov, Tel-Aviv, Israel
| | - Ofer Yossepowitch
- Affiliated to School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
- Department of Urology, Tel-Aviv Sourasky Medical Center Ichilov, Tel-Aviv, Israel
| | - Mario Sofer
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
- Affiliated to School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel.
- Department of Urology, Tel-Aviv Sourasky Medical Center Ichilov, Tel-Aviv, Israel.
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Pandolfo SD, Del Giudice F, Chung BI, Manfredi C, De Sio M, Damiano R, Cherullo EE, De Nunzio C, Cacciamani GE, Cindolo L, Porpiglia F, Mirone V, Imbimbo C, Autorino R, Crocerossa F. Robotic assisted simple prostatectomy versus other treatment modalities for large benign prostatic hyperplasia: a systematic review and meta-analysis of over 6500 cases. Prostate Cancer Prostatic Dis 2023; 26:495-510. [PMID: 36402815 DOI: 10.1038/s41391-022-00616-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused by large prostate glands. We aimed to provide a wide-ranging analysis of the currently available evidence, comparing safety and effectiveness of robot-assisted simple prostatectomy (RASP) versus open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and laser EEP. METHODS A systematic search was performed across MEDLINE, EMBASE, and Web of Science databases for retrospective and prospective studies comparing RASP to OSP or LSP or laser EEP (HoLEP/ThuLEP). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design the search strategies, selection criteria, and evidence report. A meta-analysis evaluated perioperative safety and effectiveness outcomes. The weighted mean difference and risk ratio were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for RCT article assessing risk of bias. RESULTS 15 studies, including 6659 patients, were selected for meta-analysis: 13 observational studies, 1 non-randomized prospective study, and 1 randomized controlled trial. RASP was associated with statistically significant longer operative time (OT) and lower postoperative complication rate, length of stay (LOS), estimated blood loss (EBL), and transfusion rate (TR) compared to OSP. LSP showed longer LOS and lower postoperative SHIM score, with no difference in OT, EBL, and complications. Compared to laser EEP, RASP presented longer LOS and catheterization time and higher TR. ThuLEP presented shorter OT than RASP. No difference were found in functional outcomes between groups both subjectively (IPSS, QoL) and objectively (Qmax, PVR). CONCLUSION RASP has become a size-independent treatment for the management of BPO caused by a large prostate gland. It can duplicate the functional outcomes of OSP while offering a better safety profile. When compared to LSP, the latter still stands as a valid lower-cost option, but it requires solid laparoscopic skill sets and therefore it is unlikely to spread on larger scale. When compared to laser EEP, RASP offers a shorter learning curve, but it still suffers from longer catheterization time and LOS.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
- Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Benjamin I Chung
- Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Damiano
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Cosimo De Nunzio
- Urology Unit, Ospedale Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luca Cindolo
- Department of Urology, Villa Stuart, Private Hospital, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA.
| | - Fabio Crocerossa
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Savin Z, Veredgorn Y, Taha T, Alsaraia N, Lifshitz K, Nevo A, Yossepowitch O, Sofer M. En bloc holmium laser enucleation of prostate in octogenarians and nonagenarians: clinical characteristics and outcome. Lasers Med Sci 2023; 38:196. [PMID: 37644242 DOI: 10.1007/s10103-023-03866-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
Extended longevity leads to greater numbers of elderly patients with benign prostatic hyperplasia (BPH) who seek surgical solutions. We assessed the clinical characteristics and outcomes of octogenarians and nonagenarians with BPH who underwent en bloc holmium laser enucleation of prostate (HoLEP). Retrospective cohort of all consecutive HoLEP patients treated in our medical center between January 2020 and January 2023. Cohort was divided into group aged < 80 years (n = 290) and group aged ≥ 80 years (n = 77). Their demographics, presentations, indications, and outcomes were compared. Octogenarians and nonagenarians had higher rates of indwelling catheters (p = 0.00001), chronic retention (p = 0.00006), larger prostates (p = 0.03), higher American Anesthesiology Association scores (p = 0.000001), and more antiplatelet medications (p = 0.0003) at presentation. They had longer operations (median 115 vs 90 min, respectively, p = 0.0008), longer hospital stay (median 2 vs 1 day, p = 0.01E-7), a higher complication rate (17% vs 7%, p = 0.02), and a higher transitory urinary incontinence (TUI) rate (54% vs 9%, p = 0.00001). TUI was more prevalent in the older group with indwelling catheters (61% vs, 13%, p = 0.00001). The functional outcome was similar for both age groups, and all patients could void spontaneously after the procedure. En-bloc HoLEP improves urinary symptoms and quality of life in patients ≥ 80 years of age despite larger prostates, more comorbidities, and higher complications rate, compared to younger men. HoLEP bestows a significant improvement in urologic quality of life regardless of age.
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Affiliation(s)
- Ziv Savin
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel.
| | - Yotam Veredgorn
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Tarek Taha
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nimer Alsaraia
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Karin Lifshitz
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Amihay Nevo
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Mario Sofer
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
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14
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Diana P, Baboudjian M, Saita A, Uleri A, Gallioli A, Casale P, Buffi N, Pradere B, Misrai V, Gondran-Tellier B, Boissier R, Schwartzmann I, Breda A, Del Dago PJ. Same-day discharge for endoscopic enucleation of the prostate: a systematic review and meta-analysis. World J Urol 2023; 41:2099-2106. [PMID: 37395755 DOI: 10.1007/s00345-023-04471-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
PURPOSE To systematically review studies focused on the feasibility and outcomes of outpatient endoscopic enucleation of the prostate for benign prostatic obstruction. METHODS A literature search was conducted through December 2022 using PubMed/Medline, Web of Science, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Risk of bias assessment was performed according to the Newcastle-Ottawa Scale for case control studies. RESULTS Of 773 studies, ten were included in the systematic review (n = 1942 patients) and four in the meta-analysis (n = 1228 patients). The pooled incidence of successful same-day discharge was 84% (95% CI 0.72-0.91). Unplanned readmission was recorded in 3% (95% CI 0.02-0.06) of ambulatory cases. In the reported criteria-selected patients submitted to SDD surgery, the forest plot suggested a lower rate of postoperative readmission (OR 0.56, 95% CI 0.34-0.91, p = 0.02) and complications (OR 0.69, 95% CI 0.48-1, p < 0.05) rates compared to standard protocols. CONCLUSION We provide the first systematic review and meta-analysis on SDD for endoscopic prostate enucleation. Despite the lack of randomized controlled trials, we confirm the feasibility and safety of the protocol with no increase in complications or readmission rate in well-selected patients.
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Affiliation(s)
- Pietro Diana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy.
- Department of Urology, Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Spain.
- GUA Gabinete de Urología y Andrología, Las Palmas de Gran Canaria, Spain.
| | - Michael Baboudjian
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France
- Department of Urology and Renal Transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Alberto Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Paolo Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Nicolomaria Buffi
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hospital, 31130, Quint Fonsegrives, France
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Bastien Gondran-Tellier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Ivan Schwartzmann
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Pablo Juarez Del Dago
- Department of Urology, Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Spain
- GUA Gabinete de Urología y Andrología, Las Palmas de Gran Canaria, Spain
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15
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Badreddine J, Sun H, Tay K, Rhodes S, Chen D, Zell M, Jaeger I, Nevo A. The outcomes of same-day discharge following holmium laser enucleation of the prostate (HoLEP) surgeries: our experience during the COVID-19 pandemic. World J Urol 2023:10.1007/s00345-023-04410-2. [PMID: 37160451 PMCID: PMC10169120 DOI: 10.1007/s00345-023-04410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
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.
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Affiliation(s)
- Jad Badreddine
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Helen Sun
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kimberly Tay
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Stephen Rhodes
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Daniel Chen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael Zell
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Irina Jaeger
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amihay Nevo
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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16
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Assmus MA, Krambeck AE. Moses Laser Enucleation of the Prostate (MoLEP): Use of Pulse Modulated Holmium Laser Technology for Prostate Enucleation. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Riveros C, Di Valerio E, Bacchus M, Chalfant V, Leelani N, Thomas D, Jazayeri SB, Costa J. Predictors of readmission and impact of same-day discharge in holmium laser enucleation of the prostate. Prostate Int 2023; 11:20-26. [PMID: 36910904 PMCID: PMC9995658 DOI: 10.1016/j.prnil.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/22/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Holmium enucleation of the prostate (HoLEP) is becoming the gold standard for the treatment of benign prostatic hyperplasia (BPH). Our objective was to identify predictors of 30-day readmission and the impact of same-day discharge after HoLEP. Methods Using NSQIP data from 2011 to 2019, we identified men who underwent HoLEP for the treatment of BPH. We compared patients based on time of discharge and readmission status. We used multivariable logistic regression analysis (MLRA) to identify independent factors associated with 30-day readmission. Results A total of 3,489 patients met inclusion criteria with 833 (23.88%) being discharged within 24 hours and 2,656 (76.12%) discharged after 24 hours. There were 158 (4.53%) 30-day readmissions, mostly due to hematuria and urinary tract infection. Patients being readmitted were older (72 vs. 70 years old, P = 0.001), were more likely to have preoperative anemia (36.7% vs. 23.1%; P < 0.001), chronic kidney disease (29.7% vs. 19.7%; P < 0.001), bleeding disorder (10.8% vs. 2.8%; P < 0.001), higher American Society of Anesthesiologists (ASA) scores (≥3: 70.3% vs. 46.7%; P < 0.001) and a higher frailty burden (5-item modified frailty index [5i-mFI] ≥ 2: 36.1% vs. 19.1%; P < 0.001) compared to their counterparts. Factors independently associated with 30-day readmission were bleeding disorder (OR 2.89; 95% CI 1.63-5.11; P < 0.001), 5i-mFI ≥ 2 (OR 1.67; 95% CI 1.03-2.71; P = 0.038) and an ASA score ≥3 (OR 1.80; 95% CI 1.21-2.70; P = 0.004); however, same-day discharge was not found to be a significant predictor of 30-day readmissions. Conclusion The overall readmission rate after HoLEP is low. Patients discharged within 24 hours have similar rates of readmission compared to patients discharged after 24 hours. We found bleeding disorder, frailty burden, and ASA score to be independent predictors of 30-day readmission.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | | | - Michael Bacchus
- Department of Urology, University of Florida, Gainesville FL, USA
| | - Victor Chalfant
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | - Navid Leelani
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | - Devon Thomas
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | | | - Joseph Costa
- Department of Urology, University of Florida, Jacksonville, FL, USA
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Socarrás MR, del Álamo JF, Sancha FG. Long Live Holmium! EUR UROL SUPPL 2022; 48:28-30. [PMID: 36588773 PMCID: PMC9795518 DOI: 10.1016/j.euros.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Moisés Rodriguez Socarrás
- Corresponding author. Instituto de Cirugía Urológica Avanzada, Clínica Cemtro II, Avenida Vestisquero de la Condesa 48, 28035 Madrid, Spain. Tel. +34 692934078.
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Savin Z, Dekalo S, Herzberg H, Ben-David R, Bar-Yosef Y, Beri A, Yossepowitch O, Sofer M. Improving Prostatic Preoperative Volume Estimation and Planning before Laser Enucleation. J Pers Med 2022; 12:jpm12111761. [PMID: 36573723 PMCID: PMC9696623 DOI: 10.3390/jpm12111761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 12/30/2022] Open
Abstract
We aimed to validate a formula for improving the estimation of prostatic volume by abdominal ultrasound (AUS) prior to transurethral laser enucleation. A total of 293 patients treated for benign prostate hyperplasia (BPH) by laser enucleation from 2019−2022 were included. The preoperative AUS volume was adjusted by the formula 1.082 × Age + 0.523 × AUS − 53.845, which was based on specimens retrieved by suprapubic prostatectomy. The results were compared to the weight of the tissue removed by laser enucleation as determined by the intraclass correlation coefficient test (ICC). The potential impact of preoperative planning on operating time was calculated. The ICC between the adjusted volumes and the enucleated tissue weights was 0.86 (p < 0.001). The adjusted volume was more accurate than the AUS volume (weight-to-volume ratio of 0.84 vs. 0.7, p < 0.001) and even more precise for prostates weighing >80 g. The median operating time was 90 min. The adjusted volume estimation resulted in an overall shorter expected preoperative operating time by a median of 21 min (24%) and by a median of 40 min in prostates weighing >80 g. The adjustment formula accurately predicts prostate volume before laser enucleation procedures and may significantly improve preoperative planning, the matching of a surgeon’s level of expertise, and the management of patients’ expectations.
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Affiliation(s)
- Ziv Savin
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Correspondence: ; Tel.: +972-528-361-123
| | - Snir Dekalo
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Haim Herzberg
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Reuben Ben-David
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Yuval Bar-Yosef
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Avi Beri
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Ofer Yossepowitch
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Mario Sofer
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- The Endourology Unit, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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20
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Garden EB, Ravivarapu KT, Levy M, Chin CP, Omidele O, Tomer N, Al-Alao O, Araya JS, Small AC, Palese MA. The utilization and safety of same-day discharge after transurethral benign prostatic hyperplasia surgery: a case-control, matched analysis of a national cohort. Urology 2022; 165:59-66. [DOI: 10.1016/j.urology.2022.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/21/2022]
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21
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Lee MS, Assmus M, Agarwal D, Krambeck A, Large T. Holmium Laser Enucleation of Prostate: What is the True Rate of Postoperative Opioid Use? Urology 2021; 157:211-216. [PMID: 34228978 DOI: 10.1016/j.urology.2021.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine if patients were obtaining opioids after HoLEP from other sources - despite our opioid-free postoperative pathway - we utilized a national prescription drug monitoring program (PDMP) to review all patients who underwent HoLEP at our institution. METHODS We performed a retrospective review of all HoLEPs completed by two fellowship-trained surgeons. We utilized a national PDMP to determine the true rate of postoperative opioid use. The primary outcome was filling of an opioid prescription within 31 postoperative days. Student t-tests and chi-square tests were used to compare continuous and categorical variables, respectively. RESULTS From July 2018-July 2020, 284 men underwent HoLEP. Despite our opioid-free pathway, 35 men (12.4%) received postoperative opioids. Unfortunately, 41.2% of opioids were prescribed by our inpatient physician assistant on his own accord. To prevent confounding, these patients were excluded from primary analyses. Thus, only 7.4% of patients received postoperative opioids. On univariate analysis, surgeon experience, chronic opioid use, any opioid exposure, benzodiazepine use, and chronic pain were associated with postoperative opioid use. On multivariate analysis, only preoperative opioid exposure (OR 41.9, P = 0.0383) was identified as a significant variable. CONCLUSION 92.6% of patients did not obtain postoperative opioids on our opioid-free post-HoLEP pathway, but 7.4% of patients did obtain opioids from outside sources. Proper education of the surgical team is key to prevent inappropriate opioid prescribing. On multivariate analysis, we identified that any preoperative opioid exposure was associated with an increased risk of obtaining postoperative opioids.
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Affiliation(s)
- Matthew S Lee
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Mark Assmus
- Department of Urology, ndiana University School of Medicine, Methodist Hospital, Indianapolis, IN
| | - Deepak Agarwal
- Department of Urology, ndiana University School of Medicine, Methodist Hospital, Indianapolis, IN
| | - Amy Krambeck
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tim Large
- Department of Urology, ndiana University School of Medicine, Methodist Hospital, Indianapolis, IN
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