Same Day Discharge Following Holmium Laser Enucleation in Patients Assessed to have Large Gland Prostates (≥175mL)

Abstract

Background: Holmium laser enucleation of the prostate (HoLEP) is a highly effective and durable minimally invasive surgery for benign prostatic hyperplasia. Historically, alternative treatments for large glands (≥175mL) are associated with prolonged length of stay (LOS) and postoperative catheterization. However, advances in laser technology combined with surgical technique optimization have early evidence supporting same day discharge. We look to examine contemporary same day discharge outcomes for large glands. Materials & Methods: With IRB approval we queried our EMR and retrospective clinical registry to examine perioperative outcomes of large gland (≥175mL) prostates that underwent HoLEP with consideration for same day discharge. Results: From 12/10/2019 to 09/29/2020 we identified 55 patients with a preoperative prostate size ≥175mL (39 CT, 12 MRI, 4 TRUS), of which 45 were scheduled for same day discharge and 10 for admission. Mean preop prostate size was 229.9mL (range 175-535mL) and 36 (65.5%) were in urinary retention. Mean preop PSA was 8.58ng/mL, AUA Symptom Score 22.3, and Qmax 8.8mL/s. At 3 months postop follow up mean AUASS was 6.7, PSA 0.87ng/mL and Qmax 20.4mL/s. All comer same day discharge rate was 70% (38/55). Of patients planned for same day discharge 38/45 (84%) were successful. Average LOS for all patients was 11.8h with catheterization of 21.2h. When compared to 2010 published large gland outcomes, our current LOS represents a 220% reduction. Looking specifically at patients planned for same day discharge, average LOS and catheter duration was 8.8h and 17.0h, while LOS and catheter duration for patients planned for admission was 25.7h and 39.4h, respectively. Conclusions: We report the first outcomes of preoperatively planned same day discharge for HoLEP in large glands (≥175mL). A combination of technologic advances and optimization of technique have allowed for a safe adoption of same day discharge, providing additional advantages over alternative large gland treatments.