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Licari LC, Bologna E, Manfredi C, Franco A, Ditonno F, DE Nunzio C, Franco G, Cindolo L, Leonardo C, Adelstein SA, Fiori C, Cherullo EE, Olweny EO, Autorino R. Postoperative urinary incontinence following BPH surgery: insights from a comprehensive national database analysis. Minerva Urol Nephrol 2024; 76:618-624. [PMID: 39320252 DOI: 10.23736/s2724-6051.24.05802-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
BACKGROUND Postoperative urinary incontinence (UI) is a feared complication of BPH surgery. Our study aims to investigate the incidence of UI among patients undergoing different procedures for BPH. METHODS A retrospective analysis was conducted using a large national database, containing patient records between 2011 and 2022. The most employed surgical procedures for BPH were considered, including TURP, Transurethral Incision of the Prostate (TUIP), Holmium/Thulium Laser Enucleation of the Prostate (HoLEP/ThuLEP), Open Simple Prostatectomy (OSP), minimally invasive simple prostatectomy (Lap/Rob SP), Photoselective Vaporization of the Prostate (PVP), Prostatic Urethral Lift (PUL), Robotic Waterjet Treatment (RWT - Aquablation®), Water Vapor Thermal Therapy (WVTT - Rezum®) and Prostatic Artery Embolization (PAE). Rates of any type of UI, including stress UI (SUI), urge UI (UUI) and mixed UI (MUI) were assessed. Multivariate regression analysis was used to identify predictors of "persistent" postoperative UI, defined as the presence of an active UI diagnosis at 12 months post-surgery. RESULTS Among 274,808 patients who underwent BPH surgery, 11,017 (4.01%) experienced persistent UI. UUI rates varied between 0.62% (PAE) and 2.71% (PVP), SUI ranged from 0.04% (PAE) and 2.75% (Lap/Rob SP), while MUI between 0.11% (PAE) and 1.17% (HoLEP/ThuLEP). On multivariable analysis, HoLEP/ThuLEP (OR 1.612; 95% CI: 1.508-1.721; P<0.001), PVP (OR 1.164; 95% CI:1.122-1.208; P<0.001), Open SP (OR 1.424; 95% CI:1.241- 1.624; P<0.001), and Lap/Rob SP (OR 1.667; 95% CI:1.119-2.384; P<0.01) showed significant higher likelihood of UI compared to TURP. PUL (OR 0.604; 95% CI:0.566-0.644; P<0.001), WVTT (OR 0.661; 95% CI:0.579-0.752; P<0.001), RWT (OR 0.434; 95% CI:0.216-0.767; P<0.01), and PAE (OR 0.178; 95% CI:0.111-0.269; P<0.001) were associated with lower likelihood of UI. CONCLUSIONS UI remains a concerning complication following BPH surgery, but it is an uncommon event affecting <5% of patients. Some differences in UI rates and risk might exist among various BPH procedures. These findings underscore the need for thorough patient selection and counseling.
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Affiliation(s)
- Leslie C Licari
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giorgio Franco
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Luca Cindolo
- Department of Urology, Villa Stuart, Private Hospital, Rome, Italy
| | | | | | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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Pramod N, Henry F, Ramanujan S, Jevnikar W, Bena J, Schwartz R, Jeffery J, Sorkhi S, Sauer R, McNall S, Freeman S, Wymer K, Mandeville J, Civellaro S, Humphreys M, Bhojani N, De S. High-Risk Patients Undergoing Holmium Laser Enucleation of the Prostate Have Fewer Infections with a Longer Course of Preoperative Antibiotics. J Endourol 2024; 38:598-604. [PMID: 38829325 DOI: 10.1089/end.2023.0503] [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: 06/05/2024] Open
Abstract
Introduction: There are minimal data to guide antibiotic management of patients undergoing holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia. Specifically, management of high-risk patients who are catheter dependent or have positive preoperative urine cultures varies widely. We aimed to evaluate the effect of preoperative antibiotic duration on infectious complications in high-risk patients undergoing HoLEP. Methods: A multi-institutional retrospective review of patients undergoing HoLEP between 2018 and 2023 at five institutions was performed. Patients were defined as high risk if they were catheter-dependent (indwelling urethral catheter, self-catheterization, or suprapubic tube) or had a positive preoperative urine culture. These patients were categorized into long course (>3 days) or short course (≤3 days) of preoperative antibiotics. The primary outcome was 30-day infectious complications defined as a positive urine culture with symptoms. A t-test or Wilcoxon rank-sum test was used for continuous variables and Fisher's exact test was used for categorical variables. Logistic regression analysis was conducted to identify associations with infectious complications. Results: Our cohort included 407 patients, of which 146 (36%) and 261 (64%) were categorized as short course and long course of preoperative antibiotics, respectively. Median preoperative antibiotic duration was 1 day (interquartile range [IQR]: 0, 3 days) and 7 days (IQR: 5, 7 days) in the short and long cohorts, respectively. Thirty-day postoperative infectious complications occurred in 11 (7.6%) patients who received a short course of antibiotics and 5 (1.9%) patients who received a long course of antibiotics (odds ratio 0.24, 95% confidence interval 0.07-0.67; p = 0.009). Variables such as age, positive urine culture, and postoperative antibiotic duration were not significantly associated with postoperative infection after propensity score weighting. Conclusion: In high-risk patients undergoing HoLEP, infectious complications were significantly lower with a long course vs short course of antibiotics. Further prospective trials are needed to identify optimal preoperative antibiotic regimens.
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Affiliation(s)
- Nikhil Pramod
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fabrice Henry
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suruchi Ramanujan
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William Jevnikar
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jim Bena
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryan Schwartz
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Ruben Sauer
- Department of Urology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shannon McNall
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Samantha Freeman
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | | | | | - Simone Civellaro
- Department of Urology, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Naeem Bhojani
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Smita De
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Patel VS, Beamer MR, H Sanford T, V Wiener S. Laser enucleation of the prostate (LEP) vs. simple prostatectomy: an analysis of hospital charges and comparison of practice trends. Int Urol Nephrol 2023; 55:3051-3056. [PMID: 37584861 DOI: 10.1007/s11255-023-03742-7] [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: 06/26/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Laser enucleation of the prostate (LEP) and simple prostatectomy (SP) are surgical treatment options for large gland Benign Prostatic Hyperplasia. While multiple studies compare clinical outcomes of these procedures, there are limited data available comparing hospital charges in the United States. Here, we present current practice trends and a hospital charge analysis on a national level using an annual insurance claims data repository. METHODS The Healthcare Cost and Utilization Project National Inpatient Sample and Nationwide Ambulatory Surgery Sample databases for 2018 were queried. CPT and ICD-10PCS codes identified patients undergoing LEP or SP, who were then compared for practice setting, total hospital charges, and payor. Laser type for LEP and surgical approach for SP could not be differentiated. RESULTS The median hospital charge of 5782 LEPs and 973 SPs is $26,689 and $51,250 (p < 0.001), respectively. LEP independently predicts a decreased hospital charge of $16,464 (p < 0.001) per case. Medicare is the primary payor for both procedures. More LEP procedures are completed in the outpatient setting (87.8%) vs. SPs (5.7%, p < 0.001). Median length of stay is longer for SP (LEP: 0, IQR: 0; SP: 3, IQR: 2-4; p < 0.001). In the Western region, LEP is least commonly performed (184, p < 0.001), most expensive ($43,960; p < 0.001), and has longer length of stay (2, p < 0.001). CONCLUSIONS LEP should be considered a cost-effective alternative to SP. Regions of the U.S. that perform more LEPs have shorter length of stay and lower hospital charges associated with the procedure.
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Affiliation(s)
- Valmic S Patel
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, USA
| | - Matthew R Beamer
- Department of Urology, SUNY Upstate Medical University, Syracuse, USA
| | | | - Scott V Wiener
- Department of Urology, SUNY Upstate Medical University, Syracuse, USA.
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Guo JN, Mistry NA, Lee MS, Dean NS, Assmus MA, Krambeck AE. Trends of Benign Prostatic Hyperplasia Procedures in Ambulatory Surgery Settings. J Endourol 2023; 37:1123-1128. [PMID: 37503627 DOI: 10.1089/end.2023.0154] [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: 07/29/2023] Open
Abstract
Introduction: Holmium laser enucleation of the prostate (HoLEP) has evidenced-based advantages in treating benign prostatic hyperplasia (BPH) relative to other interventions. Unfortunately, the adoption of HoLEP has remained relatively low in Medicare and the National Surgical Quality Improvement Program populations. HoLEPs role as an inpatient surgical intervention is changing as advancements in the technique and systems have demonstrated the feasibility of same-day discharge. Thus, our objective was to evaluate national HoLEP trends in ambulatory surgery settings from 2016 to 2019. Materials and Methods: The Nationwide Ambulatory Surgery Sample (NASS) is the largest national all-payer database of ambulatory surgical encounters, managed by the Agency for Healthcare Research and Quality. A cross-sectional retrospective analysis of the 2016 and 2019 NASS was performed. Rates of BPH surgeries were calculated and stratified by age, census region, and primary payer to compare across time points for trends. Chi-squared tests and two-sample t-tests were completed for categorical and continuous variables, respectively. Results: The total number of ambulatory BPH surgeries fell 20% between 2016 (n = 124,538) and 2019 (n = 100,593). In 2016, HoLEP lagged behind photoselective vaporization of the prostate (PVP) and transurethral resection of prostate (TURP) with 4.7% of surgeries but rose to the second most common procedure in 2019 with 8.3% of total surgeries. TURP was the most common intervention (62.6% in 2016, 90.7% in 2019). Simple prostatectomy was the most expensive intervention. By U.S. census region, more HoLEPs were carried out in the South (43.1% in 2016, 37.5% in 2019) and Midwest (26.8% in 2016, 31.7% in 2019). Conclusions: Overall, HoLEP uptake is increasing. HoLEP has replaced greenlight PVP as the second most frequently used intervention. The rate of ambulatory HoLEPs has nearly doubled despite a general decrease in the number of surgeries.
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Affiliation(s)
- Jenny N Guo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Neil A Mistry
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew S Lee
- Department of Urology, Ohio State University, Columbus, Ohio, USA
| | - Nicholas S Dean
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark A Assmus
- Section of Urology, Department of Surgery, University of Calgary, Calgary, Canada
| | - Amy E Krambeck
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Weinstein IC, Wu X, Arenas-Gallo C, Zhu A, Brant A, Al Awamlh BAH, Gaffney C, Lee R, Zell M, Jaeger I, Ponsky L, Shoag J. Adoption and Outcomes of Holmium Laser Enucleation of the Prostate in the United States. Urology 2023; 179:106-111. [PMID: 37328009 DOI: 10.1016/j.urology.2023.05.028] [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: 02/13/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To investigate the utilization of holmium laser enucleation of the prostate (HoLEP) using a large real-world cohort. We compare the safety, readmission, and retreatment rates of HoLEP to other widely used endoscopic surgical interventions for benign prostatic hyperplasia (BPH) including transurethral resection of the prostate (TURP), photoselective vaporization of the prostate, and prostatic urethral lift. METHODS Men who underwent endoscopic treatments for BPH from 2000 to 2019 were identified in the Premier Healthcare Database (n = 218,793). We compared the relative proportion of each procedure performed and annual physician volume data to identify trends in adoption and utilization. Readmission and retreatment rates were determined at both 30- and 90-days postoperation. Multivariable logistic regression was used to assess the association between procedure type and outcomes. RESULTS HoLEP accounted for 3.2% (n = 6967) of all the BPH procedures performed between 2000 and 2019 and increased from 1.1% of the procedures in 2008 to 4% in 2019. Patients undergoing HoLEP had lower odds of 90-days readmission compared to TURP (Odds ratio (OR) 0.87, p = 0.025). HoLEP had similar odds of retreatment compared to TURP at both 1-year (OR 0.96, p = 0.7) and 2-years (OR 0.98, p = 0.9), while patients undergoing photoselective vaporization of the prostate and prostatic urethral lift were more likely to retreat within 2-years (OR 1.20, P < 0.001; OR 1.87, P < 0.001). CONCLUSION HoLEP is a safe therapy for BPH with lower readmission and comparable retreatment rates to the gold standard TURP. Despite this, the utilization of HoLEP has lagged behind other endoscopic procedures and remains low.
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Affiliation(s)
- Ilon C Weinstein
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Xian Wu
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Camilo Arenas-Gallo
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Alec Zhu
- Department of Urology, New York, Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Aaron Brant
- Department of Urology, New York, Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | | | | | - Richard Lee
- Department of Urology, New York, Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Michael Zell
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Irina Jaeger
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lee Ponsky
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jonathan Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
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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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Zhang TR, Thorogood SL, Sze C, Fisch R, Chughtai B, Te A, Lee RK, Hu JC. Current Practice Patterns in the Surgical Management of Benign Prostatic Hyperplasia. Urology 2023; 175:157-162. [PMID: 36863599 DOI: 10.1016/j.urology.2023.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To use American Board of Urology (ABU) case log data to elucidate practice patterns for benign prostatic hyperplasia (BPH) surgery. Several surgical modalities have been introduced in recent decades causing significant practice variation. MATERIALS AND METHODS We retrospectively analyzed ABU case logs from 2008-2021 to assess trends in BPH surgery. We created logistic regression models to identify surgeon-sided factors associated with utilization of each surgical modality. RESULTS We identified 6,632 urologists who logged 73,884 surgeries for BPH. Transurethral resection of the prostate (TURP) was the most commonly performed BPH surgery in all but 1 year, and odds of performing a TURP increased year-over-year (OR 1.055, 95% CI [1.013,1.098], P = .010). The use of holmium laser enucleation of the prostate (HoLEP) did not change over time. HoLEP was more likely to be performed by urologists with higher BPH surgical volume (OR 1.017, CI [1.013, 1.021], P < .001) and with endourology subspecialization (OR 2.410, CI [1.45, 4.01], P = .001). Prostatic urethral lift (PUL) utilization increased significantly since its introduction in 2015 (OR 1.663, CI [1.540, 1.796], P < .001). PUL currently comprises over one third of all BPH surgeries logged. CONCLUSION In the face of newer technologies, TURP remains the most common surgery for BPH in the United States. PUL has been rapidly adopted while HoLEP comprises a consistent minority of cases. Surgeon age, patient age, and urologist subspecialization were associated with use of certain BPH surgical approaches.
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Affiliation(s)
- Tenny R Zhang
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Samantha L Thorogood
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Christina Sze
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Robert Fisch
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Alexis Te
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Richard K Lee
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical Center, New York, NY.
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Lee MS, Assmus MA, Ganesh M, Han J, Helon J, Mai Q, Mi X, Krambeck AE. An Outcomes Comparison Between Holmium Laser Enucleation of the Prostate, Open Simple Prostatectomy, and Robotic Simple Prostatectomy for Large Gland Benign Prostatic Hypertrophy. Urology 2023; 173:180-186. [PMID: 36586427 DOI: 10.1016/j.urology.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/13/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare perioperative outcomes between Holmium laser enucleation of the prostate (HoLEP), open simple prostatectomy (OSP), and robotic simple prostatectomy (RSP) for large prostates (> 80 cc). MATERIALS AND METHODS A retrospective study of 340 patients who underwent HoLEP (n = 209), OSP (n = 66), or RSP (n = 65) at a large academic medical center between January 2013 - September 2021 was performed. Length of stay (LOS), operative time, catheter duration, estimated blood loss (EBL), blood transfusion, and 30-day ED visits and readmissions were compared between the three groups. Univariate analyses consisted of ANOVA with Tukey's corrections and Chi-square tests. Linear and multivariate logistic regression was also performed. All tests were two-sided and a p-value <0.05 was pre-determined to be statistically significant. Analyses were performed with SAS v9.4. RESULTS HoLEP was found to have the shortest: operative time (1.4 vs 2.7 vs 3.8h), LOS (0.65 vs 4.2 vs 2.6d), and catheter duration (0.38 vs 9.9 vs 11.2d) compared to OSP and RSP, respectively (all P <.0001). HoLEP also had the lowest EBL (66 vs 795 vs 326 mL, P <.0001). HoLEP and RSP had a lower risk of blood transfusion compared to OSP (P <.0001). These associations remained significant on multivariable analyses. CONCLUSION HoLEP is a minimally invasive treatment option for large prostates that was found to have shorter operative time, LOS, and catheter duration as well as lower EBL compared to OSP and RSP.
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Affiliation(s)
- Matthew S Lee
- Department of Urology, The Ohio State University, Columbus OH.
| | - Mark A Assmus
- The University of Calgary, Southern Alberta Institute of Urology, Calgary, Canada
| | - Meera Ganesh
- Department of Urology, The Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Josh Han
- Department of Urology, The Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jessica Helon
- Department of Urology, The Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Quan Mai
- Department of Urology, The Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Xinlei Mi
- Department of Urology, The Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Amy E Krambeck
- Department of Urology, The Feinberg School of Medicine, Northwestern University, Chicago, IL
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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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10
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Shelton TM, Drake C, Vasquez R, Rivera M. Comparison of Contemporary Surgical Outcomes Between Holmium Laser Enucleation of the Prostate and Robotic-Assisted Simple Prostatectomy. Curr Urol Rep 2023; 24:221-229. [PMID: 36800115 PMCID: PMC9936114 DOI: 10.1007/s11934-023-01146-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE OF REVIEW This study reviews contemporary literature on RASP and HoLEP to evaluate perioperative outcomes, common complications, cost analytics, and future directions of both procedures. RECENT FINDINGS RASP is indicated for prostates > 80 mL, while HoLEP is size-independent. No notable differences were found in operative time, PSA nadir (surrogate for enucleation volume), re-catheterization rates, or long-term durability. Prolonged incontinence and bladder neck contracture rates are low for both surgeries. Patients experience similar satisfaction outcomes and improvements in uroflowmetry and post-void residual volumes. HoLEP demonstrates shorter hospitalizations, lower transfusion rates, lower costs, and higher rates of same-day discharge. RASP offers a shorter learning curve and lower rates of early postoperative urinary incontinence. HoLEP is a size-independent surgery that offers advantages for patients seeking a minimally invasive procedure with the potential for catheter-free same-day discharge. Future directions with single-port simple prostatectomy may offer parity in same-day discharge, but further research is needed to determine broader feasibility.
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Affiliation(s)
- T Max Shelton
- Department of Urology, Indiana University School of Medicine, 1801 North Senate Blvd., Indianapolis, IN, 46202, USA
| | - Connor Drake
- Department of Urology, Indiana University School of Medicine, 1801 North Senate Blvd., Indianapolis, IN, 46202, USA
- Indiana University School of Medicine, Indianapolis, USA
| | - Ruben Vasquez
- Department of Urology, Indiana University School of Medicine, 1801 North Senate Blvd., Indianapolis, IN, 46202, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, 1801 North Senate Blvd., Indianapolis, IN, 46202, USA.
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11
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Berk B, Acosta A, Ernandez J, Dey T, Kathrins M. Does benign prostate hyperplasia histopathological variation impact disease-specific clinical outcomes after transurethral resection? Pathol Int 2023; 73:159-166. [PMID: 36734590 DOI: 10.1111/pin.13312] [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: 08/13/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
The impact of histopathological variants in stromal and glandular tissue on clinical outcomes following transurethral resection of prostate (TURP) is unexplored. We sought to evaluate the relationship between histopathological variations in TURP specimen and postoperative clinical outcomes. We performed a retrospective analysis of men undergoing initial TURP at our institution from 2017 to 2019. All pathology slides were re-reviewed by one specialized genitourinary pathologist who was blinded to all clinical data. Types of BPH were defined as: glandular-predominant (gland:stroma ratio >50%), mixed (gland:stroma ratio 25%-50%), and stromal-predominant (gland:stromal ratio <25%). Primary clinical outcomes were ∆ post-void residual and ∆ American Urological Society Symptom Score (AUASS) at 3, 6, and 12 months post-operatively. We also evaluated for a temporal relationship between time since surgery and ∆AUASS amongst different histopathological subgroups. One hundred and five patients were included in the final analysis. 61/105 (58.1%) had glandular-predominant histopathology, 21/105 (20%) had stromal-predominant histopathology, and 23/105 (21.9%) were classified as mixed histopathology. On univariate and multivariate analysis, histopathological subtype was not a significant predictor of any of the clinical post-operative endpoints of interest at any time points. Disease-specific outcomes after TURP appear to be consistent across these different histopathologic subtypes.
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Affiliation(s)
- Brittany Berk
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andres Acosta
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John Ernandez
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tanujit Dey
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Martin Kathrins
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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12
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Hawken SR, French W, Kay H, Scales CD, Viprakasit DP, Friedlander DF. Comparison of Cost and Perioperative Outcomes Among Patients Undergoing Simple Prostatectomy and Laser Enucleation of the Prostate. J Endourol 2023; 37:60-66. [PMID: 36193580 DOI: 10.1089/end.2022.0404] [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: 01/10/2023] Open
Abstract
Introduction: Simple prostatectomy (SP) and laser enucleation of the prostate (LEP) are treatments for symptomatic benign prostatic hyperplasia (BPH) in men with large glands (e.g., >80 g). The decision between the two operations is often dependent on surgeon preference/experience and equipment availability. As the use of minimally invasive techniques, such as robotic-assisted simple prostatectomy, has increased for the treatment of large gland BPH, studies comparing the outcomes and cost of these modalities in a contemporary cohort are lacking. Methods: All-payer data from Healthcare Cost and Utilization Project State Databases from Florida, New York, California, and Maryland from 2016 to 2018 were used to identify adults who underwent SP or LEP for BPH. Patient demographics, facility characteristics, revisit rates, and cost of the index hospitalization were examined. Multivariable logistic and gamma generalized linear regression models were utilized to compare predictors of the operation performed, 30-day revisits, and index hospitalization cost among the two operations. Results: Of the 2032 patients in the cohort, 1067 (46.4%) underwent LEP and 965 (41.9%) underwent SP. On multivariable logistic regression analysis, SP patients were younger, had higher comorbidity scores, and were more likely to be uninsured compared with LEP patients. Thirty-day revisit rates among the operations were equivalent (odds ratio 0.89, 95% confidence interval 0.63-1.27, p = 0.05). The mean adjusted cost of the index hospital stay for LEP was significantly greater than that of SP ($7291 vs $6442, p = 0.04). However, our sub-group analysis examining high-volume centers revealed no significant differences in cost ($6184 vs $5353, p = 0.1). Conclusions: Across the four states examined, SP and LEP were performed with comparable volume and had similar rates of 30-day revisits. The SP was less expensive than LEP overall; however, among high-volume facilities, the cost of both operations was reduced, such that they were equivalent.
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Affiliation(s)
- Scott R Hawken
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - William French
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Hannah Kay
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Charles D Scales
- Department of Urology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Davis P Viprakasit
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - David F Friedlander
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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13
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Cooley LF, Assmus M, Ganesh M, Lee M, Helon J, Krambeck AE. Predictors of Failed Same-Day Catheter Removal After Holmium Laser Enucleation of the Prostate. Urology 2022; 170:168-173. [PMID: 35963396 DOI: 10.1016/j.urology.2022.07.047] [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: 03/11/2022] [Revised: 07/01/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To determine factors associated with failure of same-day trial of void (SDTOV) following holmium laser enucleation of the prostate (HoLEP). BACKGROUND HoLEP is increasingly utilized for patients with benign prostatic hyperplasia. Advancements in technology have improved operative efficiency and hemostasis making same-day, catheter-free discharge possible. METHODS We conducted a retrospective review on 190 patients undergoing HoLEP from July, 2021 to January, 2022 by a single center. We assessed pre- and intra-operative variables associated with our primary outcome: failure of same-day catheter removal. Post-operative complications and outcomes at a ≤7 days and 3-month follow up were examined. Continuous and categorical variables were analyzed using unpaired t-tests (Mann Whitney) and chi-square, respectively. Univariate and multivariable logistic regression models were fitted to examine the associations of failed SDTOV. RESULTS Of 190 candidates for a SDTOV, 90% (171/190) were successful. We found no difference between SDTOV success and failures with regards to age, comorbidities, presence of pre-operative urinary retention, anesthesia factors, operative time, volume resected, enucleation time, and morcellation time (all P>0.05). Pre-operatively, 26.3% (50/190) were on antiplatelet and 6.3% (12/190) were on anticoagulation. While pre-operative antiplatelet therapy was not associated with SDTOV failure (P=0.78), pre-operative anticoagulation use was (4.7% vs. 21.1%, P=0.021). Patients who continued anticoagulation through surgery had the highest rate of SDTOV failure (2.3% (4/171) vs. 15.8% (3/19), P=0.023). For those with successful SDTOV, 4.1% (7/171) required catheterization following discharge. At 3 months, no patient required catheterization. CONCLUSION On the day of surgery, patients eligible for SDTOV successfully voided 90% of the time. History of preop anticoagulation, whether continued or held, increased SDTOV failure.
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Affiliation(s)
- Lauren Folgosa Cooley
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark Assmus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Meera Ganesh
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew Lee
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jessica Helon
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amy E Krambeck
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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14
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Relationships between holmium laser enucleation of the prostate and prostate cancer. Nat Rev Urol 2022; 20:226-240. [PMID: 36418491 DOI: 10.1038/s41585-022-00678-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
Holmium laser enucleation of the prostate (HoLEP) is a size-independent surgical option for treating benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) with excellent, durable functional outcomes. The prevalence of LUTS secondary to BPH and prostate cancer both increase with age, although the two diseases develop independently. Urologists often face a diagnostic dilemma, as men with LUTS secondary to BPH might also present with an elevated PSA and, therefore, need a diagnostic work-up to exclude prostate cancer. Nevertheless, ~15% of men with a negative elevated PSA work-up will undergo HoLEP and will be diagnosed with incidental prostate cancer at the time of HoLEP. Indeed, prostate cancer is often found in men undergoing HoLEP, and this situation can be challenging to manage. Variables associated with the detection of incidental prostate cancer, strategies to reduce incidental prostate cancer, as well as the natural history and management of this condition have been extensively studied, but further work in this area is still needed.
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15
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Ganem S, Ambinder D, Kennedy A, Wong NC. A 40-Year Litigation Review of Transurethral Surgeries for Benign Prostatic Hyperplasia. Urology 2022; 168:165-168. [PMID: 35772488 DOI: 10.1016/j.urology.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/28/2022] [Accepted: 06/09/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe litigation patterns of transurethral surgery in the treatment of benign prostatic hyperplasia including verdicts, types of lawsuits, plaintiff claims, and timing of the claims. METHODS Data was gathered by searching for litigation cases between January 1, 1980 and December 1, 2021 in the Westlaw legal database using keywords for transurethral surgeries for benign prostatic hyperplasia. Extracted data included case type, general description of the plaintiffs and defendants, plaintiff claims, and whether the claim involved preoperative, perioperative, or postoperative management, verdict, and indemnity awards. RESULTS The Westlaw search yielded 44 unique cases after removing duplicate and irrelevant cases. The most common surgery resulting in a lawsuit was transurethral resection of the prostate (70%) and urologists were the most frequently named defendant (80%). The most common plaintiff claims were sexual dysfunction (36%), irritative lower urinary tract symptoms (32%), and lack of consent (27%). Among malpractice cases, the verdict was in favor of the defendant in most cases (71%) and among Eighth Amendment violation cases, the verdict was in favor of the defendant in every case. The average indemnity payment was $565,845 and the highest indemnity payment was $1,020,000. CONCLUSION Complications of transurethral surgeries and lack of consent are common reasons for patient's filing a lawsuit. Healthcare providers should ensure patient understanding of surgical risks and thoroughly document the conversation. Providers should be aware of the causes for litigation among transurethral surgeries for benign prostatic hyperplasia and of the possibility of Eighth Amendment violation lawsuits when treating prison inmates.
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Affiliation(s)
| | - David Ambinder
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | - Aidan Kennedy
- University of Maryland School of Medicine, Baltimore, MD
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Analysis of Holmium Laser Enucleation of Prostate Fixed Operating Room Times. Urology 2022; 168:86-89. [PMID: 35772482 DOI: 10.1016/j.urology.2022.06.015] [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: 01/25/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate factors influencing fixed operating room time during holmium laser enucleation of the prostate. MATERIALS AND METHODS A prospective observational study was performed for all holmium laser enucleation of the prostate (HoLEP) cases performed by a single surgeon over a 24-month period. Operating room (OR) time was divided into fixed and variable time. The variable time was defined as cut-to-close time. Fixed time included in room time to anesthesia release time (IRAT), anesthesia release time to cut time (ARCT), and close time to wheels out (CTWO). The effects of time of day and anesthesia personnel (AP) changes on fixed operating room time were evaluated. RESULTS A total of 406 HoLEPs were analyzed. There was no statistically significant difference in nonprocedural OR times between morning and afternoon surgeries (IRAT, P=0.38, ARCT P=0.10, CTWO P=0.77). Median nonprocedural OR times accounted for 27% (IQR: 22%-31%) of the total procedure time in the AM group and 29% (IQR: 24%-33%) in the PM group (P=0.005). Of the HoLEPs,78.1% (178/228) experienced one or more AP changes during the procedure. The median fixed OR time was not significantly different between procedures with 1 AP and procedures with ≥2 APs (IRAT, P=0.53; ARCT, P=0.71; CTWO, P=0.98). CONCLUSIONS Fixed operating room time makes up a significant portion of HoLEP procedures and should be considered when evaluating OR efficiency. The time of day and number of anesthesia personnel involved did not affect the fixed OR times.
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Edwins R, Bettis A, Harris AM. Evaluating Factors That Influence Healthcare Resource Utilization in Transurethral Resection of Prostate. J Endourol 2022; 36:1322-1330. [PMID: 35708111 DOI: 10.1089/end.2022.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Transurethral resection of prostate (TURP) remains the gold standard for treatment of benign prostatic hyperplasia (BPH) but is associated with complications. The association of healthcare resource utilization (HRU) and TURP has been poorly studied. We seek to evaluate HRU in patients undergoing TURP and identify factors contributing to outcomes. METHODS The National Surgical Quality Improvement Program (NSQIP) database was reviewed from 2012-2018 for TURP by CPT code. HRU was defined as discharge to continued care, unplanned readmission within 30 days, or prolonged length of stay (>75th percentile). We included preoperative variables, including age, BMI, diabetes, and ASA class. OD was broken into deciles by minutes. Preoperative characteristics and outcomes were compared against OD. Predictors of HRU were found using a stepwise multivariate logistic regression. RESULTS 38,749 patients were included. Variables significantly associated with OD (values are 3 shortest and 3 longest deciles, respectively): any HRU (35.9%, 32.4%, 31.4% and 32.4%, 33.7%, 37.6%), and prolonged length of stay (31.3%, 27.6%, 26.5% and 28.0%, 30.4%, 34.1%). Findings in the first decile seemed to be an outlier, shown in Figure 1. Complications associated with OD are shown in Figure 2. On multivariable analysis, patients with OD > 58 minutes were more likely to have increased HRU, OR 1.22, 1.33, 1.54, 1.78 for deciles 58-66, 67-78, 78-99 and >100, respectively, p<0.005. Preoperative variables associated with HRU on multivariable analysis include age 71-80 and >80, COPD, dyspnea, hypertension, diabetes, not functionally independent, ASA class III and IV-V, and dirty/infected wound class, p<0.005. CONCLUSIONS OD is an independent predictor of HRU in patients undergoing TURP and is more modifiable than other preoperative variables associated with increased HRU. Patients in the longest decile were more likely to have complications and increased HRU. Further study is needed to evaluate causation.
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Affiliation(s)
- Rebecca Edwins
- University of Kentucky, 4530, College of Medicine, 800 Rose St., Lexington, Lexington, Kentucky, United States, 40506;
| | - Amber Bettis
- University of Kentucky, 4530, Department of Surgery, Lexington, Kentucky, United States;
| | - Andrew Mitchell Harris
- University of Kentucky Medical Center, 12253, Urology, 800 Rose St., Room MS237, Lexington, Kentucky, United States, 40536-0293;
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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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Slade A, Agarwal D, Large T, Sahm E, Schmidt J, Rivera ME. Expanded Criteria Same Day Catheter Removal Following Holmium Laser Enucleation of the Prostate (HoLEP). J Endourol 2022; 36:977-981. [PMID: 35045752 DOI: 10.1089/end.2022.0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction and Objectives 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 following HoLEP was described at our institution in 2020 following a 30-patient pilot trial. We now present an expanded update following widespread adoption at our facility. Methods We reviewed patients who underwent same day catheter removal after HoLEP between 1/1/2020 and 3/21/2021. 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. Results 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 61.5cc, 35% were dependent on catheterization for urinary retention preoperatively and 9% were on antiplatelet/anticoagulant therapy. A total of 26.5% of patients with ASA 3 or 4 failed catheter removal compared to 3.9% of patients with ASA 1 or 2 (Likelihood ratio 9.32, p=0.002), ASA status lost significance on multivariate analysis (p=0.076). Successful catheter removal was not significantly associated with age, BMI, prostate size, catheter dependency, anticoagulation/antiplatelet therapy, AUA symptom score, prior BPH surgery, or prostate cancer in final pathology. Conclusion 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.
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Affiliation(s)
- Austen Slade
- Indiana University School of Medicine, 12250, Urology, 535 N Barnhill Drive, Suite 150, Indianapolis, Indiana, United States, 46202-5114;
| | - Deepak Agarwal
- Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States;
| | - Tim Large
- Indiana University School of Medicine, 12250, Urology, 1801 N Senate Blvd, Suite 220, Indianapolis, Indiana, United States, 46202;
| | - Erica Sahm
- Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States;
| | - Jonathan Schmidt
- Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States;
| | - Marcelino E Rivera
- Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States;
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Barriers to Implementation of a Same-Day Discharge Pathway for Holmium Laser Enucleation of the Prostate. Urology 2021; 161:105-110. [PMID: 34973241 DOI: 10.1016/j.urology.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate perceived barriers to successful same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) from the perspective of surgical and nursing staff members. METHODS A 17-question survey was administered to intraoperative and postoperative surgical staff in June 2021 after a six-month period of implementing a SDD HoLEP pathway with same-day catheter removal. McNemar's and Stuart-Maxwell tests were performed for statistical analysis. RESULTS Surveys were completed by 30 respondents. The majority of respondents had less than 5 years of surgical experience (63%). Almost all respondents (96%) felt that HoLEP patients could be discharged safely on day of surgery. Overall, 60% felt that HoLEP had a lower risk of post-operative bleeding compared to other transurethral surgeries. There was a significant decrease in number of respondents that felt apprehensive when comparing initiation of SDD HoLEP pathway to 6-months post-implementation (43% vs 7%, P = .003). The most common factors causing apprehension both pre- and post-implementation included: degree of hematuria (43% vs 40%, P = .56), risk of failure of trial of void (40% vs 30%, P = .26), and risk of readmission or unplanned emergency department (ED) visit (33% vs 30%, P = .48). There was a significant decrease in the number of respondents who were apprehensive about lack of experience with SDD after HoLEP comparing pre- and post-implementation (20% vs 0%, P = .01). CONCLUSION While staff report initial apprehension regarding implementation of a SDD HoLEP pathway, adequate support to intraoperative and postoperative teams helps build experience that alleviates these concerns.
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21
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Kim TH, Song PH. Anatomical endoscopic enucleation of bladder outlet obstruction. Yeungnam Univ J Med 2021; 39:12-17. [PMID: 34749443 PMCID: PMC8895962 DOI: 10.12701/yujm.2021.01522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 12/04/2022] Open
Abstract
Anatomical endoscopic enucleation of the prostate (AEEP) differs from other endoscopic modalities for bladder outlet obstruction (BOO) because it extracts the whole benign prostatic hyperplasia component. AEEP has been launched for almost 40 years as a first-line treatment method for BOO regardless of prostate size according to several guidelines. However, it remains underperformed worldwide. In this review article, we elaborate on the advantages and disadvantages of AEEP compared to other surgical modalities for BOO to investigate its efficacy and safety as a gold standard surgical management option for males with BOO.
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Affiliation(s)
- Tae Hyo Kim
- Department of Urology, College of Medicine, Dong-A University, Busan, Korea
| | - Phil Hyun Song
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
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22
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Darwish OM, Lutnick E, Dalimov Z, Waisanen KM, Wang D, Houjaij A, Jung I, Nader ND. Neuraxial vs General Anesthesia: 30-Day Mortality Outcomes Following Transurethral Resection of Prostate. Urology 2021; 157:274-279. [PMID: 34274392 DOI: 10.1016/j.urology.2021.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/06/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the occurrence of 30-day mortality, and other procedure related morbidities in cohorts of patient receiving neuraxial anesthesia (NAX) or general anesthesia (GA) in the setting of transurethral resection of the prostate (TURP). Historically, NAX has been recommended for patients undergoing TURP permitting monitoring of consciousness and early diagnosis of absorption-related hyponatremia. We aim to analyze a broader comparison of mortality and other associated morbidities regarding the form of anesthesia utilized. METHODS The National Surgical Quality Improvement Program (NSQIP) database was accessed and queried from January 2010 to December 2016 for TURP. 28,486 TURP cases were identified and further stratified by the type anesthesia administration, NAX 7,261 and GA 21,225. Chi-square analyses and Kaplan-Meier tests were performed for univariate comparisons. Using propensity score, data were optimally (1:1) matched to account for potential confounding variables. Outcomes were then compared for NAX vs. GA with a primary endpoint of 30-day mortality, followed by secondary endpoint of adverse outcomes reported per NSQIP. RESULTS Prior to matching, 30-day mortality was found to be 0.4% in the NAX cohort and 0.7% GA. 12,180 patients equally matched between the 2 groups. NAX was found to be superior to GA in terms of 30-day survival benefit (OR 0.55, 95% CI 0.33 -0.92, P <0.05), sepsis (OR 0.60, 95% CI 0.50 -0.73, P <0.001), and return to operating room (OR 0.76, 95% CI 0.60 -0.98, P <0.05) when comparing matched cohorts. NAX was associated with lower incidence of overall adverse clinical outcomes 12.4% vs 13.7% (P = 0.036). CONCLUSION NAX was found to have statistically relevant advantage for 30-day postoperative outcomes when compared to GA for TURP based on NSQIP database reporting.
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Affiliation(s)
- Oussama M Darwish
- Department of Urology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; Veterans Health Administrations Western New York Healthcare System, Buffalo, New York
| | - Ellen Lutnick
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
| | - Zafardjan Dalimov
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Kyle M Waisanen
- Department of Urology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Daniel Wang
- Department of Urology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Ali Houjaij
- Department of Urology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; Veterans Health Administrations Western New York Healthcare System, Buffalo, New York
| | - Ichabod Jung
- Department of Urology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Nader D Nader
- Veterans Health Administrations Western New York Healthcare System, Buffalo, New York; Department of Anesthesiology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
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Safety and efficacy of TURP vs. laser prostatectomy for the treatment of benign prostatic hyperplasia in multi-morbid and elderly individuals aged ≥ 75. World J Urol 2021; 39:4405-4412. [PMID: 34232353 DOI: 10.1007/s00345-021-03779-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the safety and durability of transurethral resection of the prostate (TURP) and Laser prostatectomy (LP) among multi-morbid and elderly patients. METHODS Using data retrieved from the New York State Department of Health Statewide Planning and Research Cooperative System and the California Office of Statewide Health Planning and Development, we selected cohorts of 1) multi-morbid (Charlson comorbidity index ≥ 3) and 2) elderly (aged ≥ 75) patients with benign prostatic hyperplasia who underwent laser coagulation, vaporization, enucleation, or TURP between January 2005 and December 2016. We assessed the post-operative incidence of hospital readmission and ER visit at 30 days and 90 days, complications at 90 days, and reoperation and the development of urethral stricture at 6 months or longer. RESULTS We found 12,815 and 29,806 patients in the multi-morbid and elderly cohort, respectively. Compared to LP, TURP was associated with lower odds of 90-day hospital readmission and ER visit in the multi-morbid cohort (OR 0.92, 95% CI 0.85-1.00) and higher odds in the elderly cohort (OR 1.07, 95% CI 1.01-1.14). The multi-morbid cohort showed lower odds of urinary tract infections (Ref: LP, OR 0.83, 95% CI 0.73-0.93). The elderly cohort showed higher odds of experiencing hematuria (OR 1.28, 95% CI 1.03-1.59) post TURP. TURP was associated with a 19% (95% CI 0.66-1.00) and 20% (95% CI 0.71-0.91) reduced hazard of reoperation at 6 months or longer for multi-morbid and elderly cohorts, respectively. CONCLUSION Compared to LP, TURP was associated with higher complication rates for the multi-morbid and elderly cohorts overall but a lower hazard of reoperation, supporting its durability.
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Dowd K, ElMansy H, Shahrour W, Kotb AF, Shaver C, El Tayeb M. WOLF® PIRANHA VERSUS STORZ® PROSTATE MORCELLATION DEVICES: A RETROSPECTIVE MULTI-INSTITUTIONAL STUDY. J Endourol 2021; 35:1671-1674. [PMID: 34128395 DOI: 10.1089/end.2020.0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Holmium laser enucleation of the prostate (HoLEP) entails both enucleation and morcellation. Only three popular prostate morcellation devices (PMDs) are available for this procedure. In this study, a retrospective review was done to compare the Wolf and Storz morcellators. MATERIALS AND METHODS After IRB approval, a multi-institutional retrospective chart review of prospectively collected data was performed at two institutions with a single surgeon at each center performing HoLEP. Thunder Bay Regional Health Sciences Centre employed the Storz morcellator while Baylor Scott and White Medical Center used the Wolf. Preoperative, perioperative, postoperative, and demographic data for both sets of patients were analyzed and compared retrospectively. RESULTS 506 patients in the Wolf cohort and 60 patients in the Storz cohort were analyzed. Morcellated pathologic weight was 52.3 g in the Wolf Arm and 101.7 g on the Storz arm (p < 0.0001). Overall, average morcellation rates were faster in the Storz arm; morcellation rate was 5.8 g/min for Wolf and 6.7 g/min in the Storz (p=0.0015). Morcellator malfunction was significantly lower in Wolf cohort 0% vs. 6.6% in the Storz (p=0.0001), but this did not significantly slow morcellator efficiency times. The total number of mucosal bladder injuries was comparable with rates of 1.4% and 1.6% in the Wolf and Storz groups, respectively (p=0.59). Duration of hospital stay and catheterization were less than 24 hours in both groups. CONCLUSIONS In this retrospective study, the Storz Drillcut had higher efficacy in morcellation when compared to Wolf Piranha. However, it was associated with more malfunctions. Both morcellators have comparable rates of complications and perioperative outcomes.
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Affiliation(s)
- Katherine Dowd
- Scott and White Healthcare, 293755, Urology, Temple, Texas, United States;
| | - Hazem ElMansy
- Thunder Bay Regional Health Sciences Centre, 27373, Thunder Bay, Ontario, Canada;
| | - Walid Shahrour
- Thunder Bay Regional Health Sciences Centre, 27373, Thunder Bay, Ontario, Canada;
| | - Ahmed Fouad Kotb
- Northern Ontario School of Medicine, 26627, Urology, Thunder Bay, Ontario, Canada;
| | - Courtney Shaver
- Scott and White Healthcare, 293755, Temple, Texas, United States;
| | - Marawan El Tayeb
- Scott and White Healthcare, 293755, Urology, Temple, Texas, United States;
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Magistro G, Schott M, Keller P, Tamalunas A, Atzler M, Stief CG, Westhofen T. Enucleation vs. Resection: A Matched-pair Analysis of TURP, HoLEP and Bipolar TUEP in Medium-sized Prostates. Urology 2021; 154:221-226. [PMID: 33891930 DOI: 10.1016/j.urology.2021.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate efficacy and safety of holmium laser enucleation of the prostate (HoLEP), bipolar enucleation of the prostate (bTUEP) and transurethral resection of the prostate (TURP) in medium-sized prostates (50cc). METHODS We present a retrospective analysis of 2230 patients treated for lower urinary tract symptoms. We analysed perioperative parameters, short-term clinical outcomes and adverse events in matched-pair cohorts. RESULTS Both HoLEP and bTUEP were superior in terms of efficacy compared to TURP (surgery time: 51min and 50min vs. 60min; P < 0.001; tissue retrieval percentage: 71.4% and 70% vs. 50%; P < 0.001) and showed stronger improvement of LUTS (change IPSS: -15 and -14 vs. -10; P = 0.008). Furthermore, urodynamic parameters (Qmax: +15 ml/s and +19 ml/s vs. +12 ml/s; P < 0.001; PVR: -100 ml and -95 ml vs. - 80ml; P < 0.008) were significantly more improved after enucleation than after TURP. All techniques showed an equally low complication rate (6.9% and 6.9% vs. 10.3%; P = 0.743). No relevant difference of clinical outcomes was identified between HoLEP and bTUEP. CONCLUSION Both resection and enucleation are efficient and safe procedures in patients with medium-sized prostates (50cc), but irrespective of the technical approach, transurethral enucleation is superior to TURP in terms of perioperative and functional outcomes.
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Affiliation(s)
- Giuseppe Magistro
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Melanie Schott
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Patrick Keller
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Alexander Tamalunas
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Thilo Westhofen
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
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Jiang DD, Hayes M, Gillis KA, Korets R, Wagner AA, Hedges JC, Chakiryan NH. Misaligned Incentives in Benign Prostatic Enlargement Surgery: More Complex and Efficacious Procedures Are Earning Fewer Relative Value Units. J Endourol 2021; 35:835-839. [PMID: 33222524 DOI: 10.1089/end.2020.0941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Relative value units (RVUs) are the measure of value used in US Medicare reimbursement. Medicare determines physician work RVUs (wRVUs) from the Relative Value Update Committee (RUC) for a procedure based on operative time, technical skill and effort, mental effort and judgment, and stress. In theory, work RVUs should account for the complexity and operative time involved in a procedure. The aim of this study was to assess whether major procedures for treatment of benign prostatic enlargement (BPE) are fairly compensated based on complexity and operative time in the RVU system and compare them with the intended reimbursement. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and the Centers for Medicare and Medicaid Services (CMS) Medicare Physician Fee Schedule were queried from 2015 to 2017. Single, current, procedural terminology codes associated with BPE treatments were included: transurethral resection of the prostate (TURP), photovaporization of the prostate (PVP), holmium laser enucleation of the prostate (HoLEP), retropubic simple prostatectomy (RSP), and suprapubic simple prostatectomy (SSP). The CMS operative times and the NSQIP real data were used in turn to calculate separate values for wRVUs per hour (wRVUs/hr) of operative time. The wRVUs/hr derived from CMS operative times represent RUC-estimated wRVUs/hr and wRVUs/hr derived from NSQIP represent actual wRVUs/hr. Results: A total of 27,664 cases were included from the NSQIP dataset. Median wRVU was 15.3 (interquartile range [IQR] 12.2-15.3), median operative time 50 minutes (IQR 33-74), and median wRVUs/hr 17.0 (IQR 11.6-26.2). RUC-estimated wRVUs/hr were TURP 12.2, PVP 12.2, RSP 9, SSP 9.3, and HoLEP 7.3. The actual wRVUs/hr were TURP 19.1, PVP 15.5, RSP 10.2, HoLEP 9.4, and SSP 7.6. Conclusions: Laser enucleation and simple prostatectomy are highly complex and efficacious procedures for treating BPE, yet the current payment schedule assigns these procedures the least amount of wRVUs/hr. Financial incentives for performing BPE surgeries are clearly misaligned.
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Affiliation(s)
- Da David Jiang
- Oregon Health and Science University, Portland, Oregon, USA.,O'Brien Research Group, Portland, Oregon, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mitchell Hayes
- Oregon Health and Science University, Portland, Oregon, USA
| | - Kyle A Gillis
- Oregon Health and Science University, Portland, Oregon, USA.,O'Brien Research Group, Portland, Oregon, USA.,University of Iowa Health Care, Iowa City, Iowa, USA
| | - Ruslan Korets
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andrew A Wagner
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jason C Hedges
- Oregon Health and Science University, Portland, Oregon, USA
| | - Nicholas H Chakiryan
- Oregon Health and Science University, Portland, Oregon, USA.,O'Brien Research Group, Portland, Oregon, USA.,H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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27
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Same Day Discharge is a Successful Approach for the Majority of Patients Undergoing Holmium Laser Enucleation of the Prostate. Eur Urol Focus 2021; 8:228-234. [PMID: 33414073 DOI: 10.1016/j.euf.2020.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/03/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Limited research has focused on success with hospital discharge on the same day of surgery after holmium laser enucleation of the prostate (HoLEP). OBJECTIVE To determine the success of same-day discharge in our HoLEP cohort and factors associated with this approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of our prospectively maintained HoLEP database demonstrated that 473 adult males underwent HoLEP from July 2018 to December 2019 at a tertiary referral center and high-volume HoLEP hospital. Patients were divided into groups according to planned inpatient admission (PIA), successful same-day discharge (SDD), or unplanned admission (UA). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The PIA, SDD, and UA groups were assessed for differences in preoperative demographic data, perioperative surgical data, and postoperative follow-up data. SDD and UA were then compared to determine if any specific factors predicted UA, including univariate and multivariate logistic regression analyses. RESULTS AND LIMITATIONS Age (p = 0.0049), use of anticoagulation (p = 0.037), American Society of Anesthesiologists score of 3-4 (p = 0.0017), and enucleation time (p=0.0178) were significantly higher in the PIA group. Morcellation time (p = 0.0059) and the rate of bedside catheter irrigation (p = 0.04) were higher in the UA group. The SDD group had the highest rate of successful voiding trial (p = 0.0001). Among the three groups, there was no difference in the rate of postoperative complications (p = 0.141). In a comparison of the SDD and UA groups, morcellation time (p = 0.041), the rate of bedside clot evacuation (p = 0.004), and successful voiding trial (p = 0.003) all favored SDD. There was no difference in 90-d complications (p = 0.536). A limitation is the retrospective nature of this study. CONCLUSIONS HoLEP can be successfully performed as day surgery without an increase in postoperative complications. HoLEP as day surgery is possible for any patient who does not require admission for medical comorbidities. PATIENT SUMMARY Same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) is possible and is successful in 87.4% of patients. Patients with longer morcellation times and with post-procedure hematuria with clots are more likely to have an unplanned admission. Use of a 120-W modulated-pulse laser resulted in a higher rate of SDD success. The culture change to day surgery is time-intensive owing to education of the postsurgical care units and clinic staff, and in our experience took approximately 9 mo to seamlessly integrate SDD as our HoLEP standard of care.
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28
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Campbell RA, Gill BC. Medication Discontinuation Following Transurethral Prostatectomy: an Unrecognized Effectiveness Measure? Curr Urol Rep 2020; 21:61. [PMID: 33159617 DOI: 10.1007/s11934-020-01015-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Freedom from medication is a common goal for patients undergoing surgical treatment of benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS). Knowing medication discontinuation rates following various forms of transurethral prostatectomy may aid patient counseling and assessing the comparative effectiveness of different approaches. This review examined discontinuation rates of BPH/LUTS medications following transurethral prostatectomy. RECENT FINDINGS Rates of BPH/LUTS medication use after transurethral resection of the prostate varied from 15% to 55%, and discontinuation rates were 54-95% across medications and follow-up periods. For laser prostatectomy, approximately 18% of patients continued medications postoperatively and discontinuation rates ranged from 53% to 75%. Minimal data on holmium laser enucleation existed. For reference, medication discontinuation rates after transurethral needle ablation or microwave therapy were only 15-28%. No recommendations or best practices inform the use of medical therapy following BPH surgery. Rates of BPH/LUTS medication use following transurethral prostatectomy are considerable.
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Affiliation(s)
- Rebecca A Campbell
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Mail Stop Q10-1, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Bradley C Gill
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Mail Stop Q10-1, 9500 Euclid Ave, Cleveland, OH, 44195, USA. .,Department of Urology, Cleveland Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH, USA. .,Section of Urology, Surgical Service, Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.
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29
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Catheter Removal on the Same Day of Holmium Laser Enucleation of the Prostate: Outcomes of a Pilot Study. Urology 2020; 146:225-229. [PMID: 33045290 PMCID: PMC7547315 DOI: 10.1016/j.urology.2020.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022]
Abstract
Objective To determine if same day catheter removal is feasible in a select population after holmium laser enucleation of the prostate (HoLEP). Methods We performed an analysis of patients undergoing HoLEP at our institution who underwent same-day catheter removal after HoLEP. All HoLEPs were performed with Moses 2.0 Optimized for BPH. Patients were dismissed from postoperative recovery unit to the clinic for catheter removal and voiding trial. Results To date, 30 patients have undergone same day catheter removal. Median age is 68.6 years (interquartile range [IQR] 61.8-73.3) and preoperative prostate volume 81 mL (IQR 53-114.8). Median enucleation time was 39.5 minutes (IQR 30.5-53), morcellation time was 5 minutes (IQR 4-12 minutes), and enucleated specimen weight was 52.5 g (IQR 33-81). Twenty-seven (90%) patients successfully voided on the same day without requiring catheter replacement. All patients were catheter free by POD1. For patients who successfully passed their voiding trial, the median time from the end of the procedure to hospital discharge was 2.6 hours (IQR [2.1-2.9]) and from the end of the HoLEP to catheter removal was 4.9 hours (IQR [3.5-6.0]). Conclusion We present for the first time that same day catheter removal is a feasible option in a select population of patients undergoing HoLEP. With more study, this has the potential for transforming the management of BPH, especially larger glands.
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30
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Manov JJ, Mohan PP, Kava B, Bhatia S. Benign Prostatic Hyperplasia: A Brief Overview of Pathogenesis, Diagnosis, and Current State of Therapy. Tech Vasc Interv Radiol 2020; 23:100687. [PMID: 33308528 DOI: 10.1016/j.tvir.2020.100687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As prostatic artery embolization is assuming an increasingly important role in the management of benign prostatic hyperplasia, it is important for the practicing interventional radiologist to have a deep understanding of all aspects of the disease process and the available treatment options. This paper provides a comprehensive overview of the pathophysiology, diagnosis and management options for benign prostatic hyperplasia with an emphasis on the surgical and medical treatments.
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Affiliation(s)
- John J Manov
- Department of Radiology, University of Miami, Miller School of Medicine, FL.
| | - Prasoon P Mohan
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, FL
| | - Bruce Kava
- Department of Urology, University of Miami, Miller School of Medicine, FL
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, FL
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Merheb S, Wang N, Weinberg J, Wang DS, Wason SEL. Online interest in surgical treatment for benign prostatic hyperplasia using Google trends. World J Urol 2020; 39:2655-2659. [PMID: 32926225 DOI: 10.1007/s00345-020-03445-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/05/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Online health information-seeking behavior has increased over the past 15 years; however, little is known about the online interest for surgical treatment of men with benign prostatic hyperplasia. We used Google Trends to evaluate online interest for various surgical procedures for benign prostatic hyperplasia in the US and worldwide. METHODS Transurethral resection of the prostate, photoselective vaporization of the prostate, Holmium laser enucleation of the prostate, Urolift, and Rezum were selected as search terms of interest within Google Trends. Google Trends normalizes the popularity of search terms on a 0-100 scale. ANOVA and the average rate of change in popularity scores were conducted from July 2015 to February 2019. RESULTS From 2004 to 2019, online interest in transurethral resection of the prostate and photoselective vaporization of the prostate remained stable in the US and worldwide; meanwhile, there was an upward trend for Urolift and Rezum. There was a statistically significant increase in the online interest for Holmium laser enucleation of the prostate in the US and worldwide; however, the mean popularity score was significantly higher worldwide. CONCLUSIONS A shift in online interest towards minimally invasive surgical therapies for benign prostatic hyperplasia was demonstrated in the US and worldwide and parallels clinical practice patterns, such as HoLEP and Urolift surgical volumes in Indiana and Australia, respectively. Google Trends can be used in real-time to gauge online interest for surgical procedures and help guide physician-patient counseling.
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Affiliation(s)
- Samir Merheb
- Boston University / Boston Medical Center, 725 Albany St., Suite 3B, Boston, MA, 02118, USA
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center at Boston University, School of Public Health, Boston University, 85 East Newton St, Boston, MA, M92102118, USA
| | - Janice Weinberg
- School of Public Health, Department of Biostatistics, Boston University, 801 Massachusetts Avenue 3rd Floor, Boston, MA, 02118, USA
| | - David S Wang
- Boston University / Boston Medical Center, 725 Albany St., Suite 3B, Boston, MA, 02118, USA
| | - Shaun E L Wason
- Boston University / Boston Medical Center, 725 Albany St., Suite 3B, Boston, MA, 02118, USA.
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Gudaru K, Gonzalez Padilla DA, Castellani D, Tortolero Blanco L, Tanidir Y, Ka Lun L, Wroclawski ML, Maheshwari PN, Figueiredo FCAD, Yuen‐Chun Teoh J. A global knowledge, attitudes and practices survey on anatomical endoscopic enucleation of prostate for benign prostatic hyperplasia among urologists. Andrologia 2020; 52:e13717. [DOI: 10.1111/and.13717] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Kalyan Gudaru
- Department of Urology University Hospitals of North Midlands NHS Trust Stoke‐on‐Trent UK
| | | | | | | | - Yiloren Tanidir
- Department of Urology Marmara University School of Medicine Istanbul Turkey
| | - Lo Ka Lun
- S.H. Ho Urology Centre Department of Surgery The Chinese University of Hong Kong Hong Kong China
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein São Paulo Brazil
- BP ‐ A Beneficência Portuguesa de São Paulo São Paulo Brazil
| | | | | | - Jeremy Yuen‐Chun Teoh
- S.H. Ho Urology Centre Department of Surgery The Chinese University of Hong Kong Hong Kong China
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Wroclawski ML, Teles SB, Carneiro A. Anatomical endoscopic enucleation of the prostate: The next gold standard? No! (or not yet!). Andrologia 2020; 52:e13707. [PMID: 32559344 DOI: 10.1111/and.13707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
Most cases of lower urinary tract symptoms due to benign prostatic hyperplasia are initially managed through medical therapy. In cases that surgery is indicated, the anatomical endoscopic enucleation of the prostate (aEEP), first described in 1983, allegedly presents the same safety profile as the best endoscopic non-enucleating procedures and the same long-term functional outcomes as simple prostatectomy. Thus, why aEEP has not yet been consolidated as the gold-standard BPH surgical treatment? The main reasons are as follows: (a) Multiple energy sources and techniques; (b) High costs; (c) Steep learning curve; (d) Rare in-residency training; (e) Reimbursement issues; (f) Outcomes and (g) Complications. We do believe aEEP is an important advance and a "practice-changing" procedure that will play an important role in the BPH surgical options arsenal, especially for larger prostates. However, there is a need to start an in-residency training program, with a mentor guidance, and, over time, the cost will likely be reduced due to greater competition between companies and greater support from health insurers. Considering these points, in the future, EEP may be considered the gold-standard treatment for BPH… but not yet.
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Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,BP - a Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Borofsky MS. Editorial Comment on: "Mind the Gaps: Adoption and Underutilization of Holmium Laser Enucleation of the Prostate in the United States from 2008 to 2014" by Robles et al. J Endourol 2020; 34:776-777. [PMID: 32312085 DOI: 10.1089/end.2020.0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael S Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
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Robles J, Pais V, Miller N. Mind the Gaps: Adoption and Underutilization of Holmium Laser Enucleation of the Prostate in the United States from 2008 to 2014. J Endourol 2020; 34:770-776. [PMID: 31880957 DOI: 10.1089/end.2019.0603] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: There is increasing recognition of the advantages of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hypertrophy (BPH) treatment in the United States but relatively little is known about the extent of HoLEP adoption over time. This study aims to assess national HoLEP adoption rates and regional trends from 2008 to 2014. Methods: We retrospectively analyzed a data set of 100% Medicare claims to determine the rate of U.S. HoLEP adoption in 2008, 2011, and 2014. Rates were adjusted by age and race and stratified by hospital referral region (HRR). Linear and logistic regression models were used to assess for trends in HoLEP adoption over time. Results: Total U.S. BPH cases decreased 24% from 2008 to 2014 and HoLEP cases increased significantly from 1086 (2008) to 3368 (2014). Despite this, HoLEP accounted for just 4% of total BPH cases in 2014. In 2008, 28/306 (9%) of HRRs recorded >10 HoLEP cases per year. This increased to 89 HRRs (29%) in 2011 but stabilized at 94 HRRs (31%) in 2014. In 2014, over 50% of states still had only 0 to 1 sites doing 10+ HoLEP cases per year. Conclusions: Based on this 100% sample of Medicare claims from 2008 to 2014, surgical BPH treatment volume has decreased, while HoLEP volume and regional adoption have tripled. However, rates of HoLEP remain extremely low at just 4% of all BPH procedures in 2014, and large regional gaps in care exist. These data indicate that HoLEP remains substantially underutilized and the majority of regions still lack access to centers performing >10 HoLEP cases per year.
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Affiliation(s)
- Jennifer Robles
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vernon Pais
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Nicole Miller
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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36
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Heidar NA, Labban M, Misrai V, Mailhac A, Tamim H, El-Hajj A. Laser enucleation of the prostate versus transurethral resection of the prostate: perioperative outcomes from the ACS NSQIP database. World J Urol 2020; 38:2891-2897. [PMID: 32036397 DOI: 10.1007/s00345-020-03100-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/19/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To compare the perioperative outcomes associated with laser enucleation of the prostate (LEP) and transurethral resection of the prostate (TURP) using a national database. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent TURP or LEP from 2008 to 2016. Baseline demographics, comorbidities, and predisposition to bleeding were compared between TURP and LEP. The 30-day perioperative outcomes including operative time, length of hospital stay (LOS), return to the operating room (OR), bleeding requiring transfusion, and organ system-specific complications were compared between the procedures. A multivariate logistic regression analysis was performed, adjusting for the type of surgery and other covariates. RESULTS The series included 37,577 TURP and 2869 LEP procedures. While TURP was associated with a shorter operative time (55.20 ± 37.80 min) than LEP (102.80 ± 62.30 min), the latter was associated with a shorter hospital stay (1.29 ± 2.73 days) than TURP (2.05 ± 5.20 days). Compared to TURP, LEP had 0.52 (0.47-0.58) times the odds of a LOS > 1 day and 0.67 (0.54-0.83) times the odds of developing urinary tract infections. Nevertheless, no difference was found for other postoperative complications, need for transfusion, and return to OR. CONCLUSION Real-life data from a large national database confirmed that LEP is a safe and reproducible procedure to treat benign prostatic obstruction. Compared to TURP, LEP was associated with a lower rate of infectious complications and a shorter LOS at the expense of an increased operative time.
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Affiliation(s)
- Nassib Abou Heidar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Muhieddine Labban
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Aurelie Mailhac
- American University of Beirut Medical Center, Clinical Research Institute, Beirut, Lebanon
| | - Hani Tamim
- American University of Beirut Medical Center, Clinical Research Institute, Beirut, Lebanon
| | - Albert El-Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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Lwin AA, Zeng J, Evans P, Phung MC, Hynes KA, Price ET, Twiss CO, Tzou DT, Funk JT. Holmium Laser Enucleation of the Prostate Is Safe and Feasible as a Same Day Surgery. Urology 2020; 138:119-124. [PMID: 31962119 DOI: 10.1016/j.urology.2020.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the safety, feasibility and treatment outcomes of holmium laser enucleation of the prostate (HoLEP) as a same day surgery (SDS). METHODS HoLEPs performed from November 2013 to December 2018 at our institution were reviewed retrospectively. Inclusion criteria for same day surgery (SDS) included living in the local metropolitan area with access to local hospital and Eastern Cooperative Oncology Group (ECOG) 0-2, regardless of prostate size and anticoagulation status. Those patients who were discharged directly from the postoperative care unit were identified as SDS cases. Patients admitted overnight after HoLEP during the same period were used as a matched cohort. Patient demographics, disease characteristics and treatment outcomes were compared. RESULTS A total of 377 patients were identified, including 199 SDS and 178 non-SDS patients. No statistical difference was present between the 2 groups regarding the post-op complication and readmission rates. The non-SDS group had a significantly higher percentage of patients with history of urinary retention, lower pre-op Qmax, and larger prostate volume. The SDS group had shorter operative time, length of stay (LOS), and catherization time (all P <.05). At 1-year follow-up, no statistically different change in Qmax, PVR, or IPSS score was noted between the 2 groups. CONCLUSION Same day outpatient surgery for HoLEP is safe in patients who live in close proximity and have ECOG status 0-2. Our readmission rate and complication rate are comparable to those reported in the literature with markedly decreased LOS. Long-term functional outcome is not compromised by SDS.
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Affiliation(s)
- Aye A Lwin
- Department of Urology, University of Arizona, Tucson, AZ
| | - Jiping Zeng
- Department of Urology, University of Arizona, Tucson, AZ
| | - Patrick Evans
- Department of Urology, University of Arizona, Tucson, AZ
| | | | - Kieran A Hynes
- Division of Urology, University of Mississippi Medical Center, Jackson, MS
| | | | | | - David T Tzou
- Department of Urology, University of Arizona, Tucson, AZ
| | - Joel T Funk
- Department of Urology, University of Arizona, Tucson, AZ.
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Large T, Nottingham C, Stoughton C, Williams J, Krambeck A. Comparative Study of Holmium Laser Enucleation of the Prostate With MOSES Enabled Pulsed Laser Modulation. Urology 2019; 136:196-201. [PMID: 31790785 DOI: 10.1016/j.urology.2019.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms secondary to benign prostate hyperplasia using 3 different laser fibers and 2 different laser energy modes. MATERIALS AND METHODS This is a review of a clinic registry of men with lower urinary tract symptoms secondary to benign prostate hyperplasia who underwent HoLEP between August 2018 and January 2019. Patients were assigned to group 1 (50 patients), group 2 (50 patients), and group 3 (50 patients) based on the HoLEP being completed with either a Slimline 550µm, Slimline 1000µm, or MOSES 550 µm laser, respectively. The groups were compared using SSPS for ANOVA comparison of means and multivariate logistic regression. RESULTS Ten patients who underwent concomitant stone surgery (2 PCNL, 8 ureteroscopy , 3 bilateral cases) and 11 patients had bladder stones removed; ancillary procedures did not significantly differ between groups(P = .2). Prostate enucleation times differed significantly (22.5 + 7.3, 16.4 + 6.9, 18.1 + 8.6 minutes P ≤.001) between groups. However, statistical significance was lost once enucleation time was indexed against enucleated tissue weight. Time to achieve hemostasis (minutes) was statistically different between groups (10.6 + 6.1, 7.7 + 5.2, 6.3 + 4.8 P <.001). This difference in hemostatic time was maintained on multilogistic regression demonstrating that MOSES laser enucleation was associated with a 3.9-minute decrease time to achieve hemostasis after enucleation compared to Slimline 550 HoLEP (P <.001). CONCLUSION Our findings suggest that modulated pulsed laser energy can improve hemostasis during the enucleation phase of a HoLEP resulting in shorter Operating Room times.
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Affiliation(s)
- Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Charles Nottingham
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Christa Stoughton
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - James Williams
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Amy Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
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Wroclawski ML, Teles SB, Amaral BS, Kayano PP, Cha JD, Carneiro A, Alfer W, Monteiro J, Gil AO, Lemos GC. A systematic review and meta-analysis of the safety and efficacy of endoscopic enucleation and non-enucleation procedures for benign prostatic enlargement. World J Urol 2019; 38:1663-1684. [DOI: 10.1007/s00345-019-02968-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/20/2019] [Indexed: 12/31/2022] Open
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Bajic P, Noriega N, Gorbonos A, Karpman E. GreenLight Laser Enucleation of the Prostate (GreenLEP): Initial Experience with a Simplified Technique. Urology 2019; 131:250-254. [DOI: 10.1016/j.urology.2019.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
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De S. EDITORIAL COMMENT. Urology 2019; 131:19-20. [PMID: 31451160 DOI: 10.1016/j.urology.2019.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Smita De
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Marchioni M, Cindolo L, Di Nicola M, Schips L, De Sio M, Lima E, Mirone V, Cormio L, Liatsikos E, Porpiglia F, Autorino R. Major Acute Cardiovascular Events After Transurethral Prostate Surgery: A Population-based Analysis. Urology 2019; 131:196-203. [PMID: 31145946 DOI: 10.1016/j.urology.2019.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/12/2019] [Accepted: 05/16/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To test the prevalence and predictors of major acute cardiovascular events (MACE) after transurethral prostate surgery (TPS). MATERIAL AND METHODS The American College of Surgeons National Surgical Quality Improvement Program database (2011-2016) was queried for patients who underwent transurethral resection of the prostate, photoselective vaporization, or laser enucleation. MACE included: cerebrovascular events, cardiac arrest, myocardial infarction, deep venous thrombosis requiring therapy, and pulmonary embolism episodes occurred up to 30 days after discharge. Univariable and multivariable logistic regression models tested MACE predictors and effect of MACE on perioperative mortality. Within covariates significant at univariable analyses a stepwise selection, based on Akaike Information Criterion values, was performed to fit the most appropriate multivariable model. RESULTS Overall 44,939 patients were included in our analyses. Of these 365 (0.8%) had MACE within 30 days after surgery. The strongest MACE predictors were recent congestive heart failure (odds ratio [OR]: 2.1, 95% confidence interval [CI]: 1.2-3.7, P = .007), transfusions (OR: 2.5, 95% CI: 1.5-4.1, P <.001) and preoperative Systemic Inflammatory Response Syndrome or sepsis (OR: 2.6, 95% CI: 1.6-4.2, P <.001). Similarly, inpatient (OR: 2.0, 95% CI: 1.6-2.5, P <.001) and nonelective (OR: 1.5, 95% CI: 1.1-2.1, P = .012) patients experienced higher MACE rates. Perioperative mortality rates were statistical significantly higher in MACE patients (OR: 13.1, 95% CI: 8.2-21.0, P <.001). CONCLUSION Up to 1% of patients undergoing transurethral prostate surgery experience MACE. MACE are burdened by high mortality rates (up to 14% in MACE patients). Proper patient selection and postoperative monitoring are necessary to reduce MACE incidence and mortality rates.
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Affiliation(s)
- Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Laboratory of Biostatistics, Chieti, Italy; Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, "SS. Annunziata" Hospital, Chieti, Italy.
| | - Luca Cindolo
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Laboratory of Biostatistics, Chieti, Italy
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, "SS. Annunziata" Hospital, Chieti, Italy
| | - Marco De Sio
- Department of Urology, Luigi Vanvitelli University of Naples, Naples, Italy
| | - Estevão Lima
- Department of Urology, Hospital of Braga, Braga, Portugal
| | - Vincenzo Mirone
- Department of Urology, Federico II University, Naples, Italy
| | - Luigi Cormio
- Department of Urology and Kidney Transplantation, University of Foggia, Foggia, Italy
| | | | - Francesco Porpiglia
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Riccardo Autorino
- Department of Surgery, Division of Urology, VCU Health, Richmond, VA
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Holmium Laser Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia: a Safe and Effective Treatment Option in our Elderly Patients. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-0281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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