Article

Rapid ambulatory pathway laser prostatectomy is safe: results within the global period.

Dartmouth-Hitchcock Medical Center, Lebanon Concord Hospital Center for Urologic Care, Concord, NH, USA.
BJU International (Impact Factor: 3.05). 02/2012; 110(8):1190-3. DOI: 10.1111/j.1464-410X.2012.10952.x
Source: PubMed

ABSTRACT Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Laser prostatectomy is a commonly performed procedure for BOO, and has been shown to have short- and medium-term results equivalent to the gold standard procedure (i.e. TURP) in various studies. It also has an advantage over TURP in that it can be performed on patients who are taking anticoagulant medication. However, patients in most studies are admitted to the hospital overnight on continuous bladder irrigation and are discharged home the next day. The present study shows that it is safe and feasible to perform laser prostatectomy in an ambulatory fashion with discharge of patients within hours of their surgery. The discharge pathway is associated with minimal morbidity or the need for admission after surgery, and the reported short-term results are in accordance with the available literature on laser prostatectomy.
•  To investigate the feasibility and safety of a rapid ambulatory discharge pathway after holmium laser ablation of the prostate (HoLAP) for the treatment of benign prostatic hyperplasia.
•  The study group comprised a cohort of 65 consecutive patients undergoing HoLAP scheduled as a day surgical case by a single surgeon between January 2007 and December 2009. •  Patients were discharged from day surgery with a catheter in place, and returned for a voiding trial on postoperative day 3. •  Preoperative, intra-operative and postoperative parameters were reviewed with follow-up data for the 90-day global postoperative period. •  Statistical analysis employed Student's t-test with P < 0.05 (two-tailed) being considered statistically significant.
•  The mean (range) patient age was 64 (41-87) years; mean (range) American Society of Anesthesiologists score was 2.2 (1-4); mean (sd) operation duration was 44 (17) min; and mean (sd) time after surgery until discharge was 149 (51) min. •  Postoperative complications included catheter occlusion (1.5%) and admission for haematuria (1.5%). •  There were no re-admissions after discharge from the hospital. •  Within the 90-day global period, 13 patients described lower urinary tract symptoms (20%), five patients had postoperative urinary retention (7.7%) and one patient had a urinary tract infection (1.5%). •  After surgery, mean American Urological Association Symptom Score decreased from 21.3 to 7.6 (P < 0.001); mean quality of life score decreased from 4.04 to 1.38 (P < 0.001); and mean post-void residual decreased from 190.2 to 46.4 mL (P < 0.001).
•  In appropriately selected patients, HoLAP can be safely performed as an ambulatory case with a rapid discharge pathway and minimal morbidity during the 90-day global period.

0 Bookmarks
 · 
101 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Day-case surgery has been made possible thanks to the development of surgical techniques such as video-assisted surgery. Mini-invasive surgery reduces the incisional size, decreases postoperative pain, and the duration of postoperative rehabilitation. Robot-assisted surgery is a new technical improvement which increases safety and accuracy of surgical procedures. Laser surgery decreases the risk of postoperative bleeding allowing day-case ablation of the prostate to be performed. Improvement in surgical management is related to: Day-case surgery is demanding, leading to surgeons, anaesthetists and all health care providers to better control patients' management, in order to improve health care quality and safety.
    La Presse Médicale 02/2014; · 0.87 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To examine the effect of resident involvement on laser prostate surgery outcomes within a urology group in a private practice setting. MATERIALS AND METHODS: Patients with ≥6 months of follow-up data who had undergone holmium laser ablation of the prostate by a single surgeon (R.L.Y.) within a private urology group were included in the present study. The patients were divided into 2 groups, with resident involvement in 1 group and no resident involvement in 1 group. The preoperative, intraoperative, and postoperative parameters were reviewed. The outcomes variables included changes in the International Prostate Symptom Score, quality of life scores, postvoid residual urine volumes, and reoperation rates. Statistical analysis used a 2-tailed Student t test with a significance level of .05. RESULTS: Of 153 holmium laser ablations of the prostate, 79 (52%) met the inclusion criteria. Of the 79 cases, 42 (53%) involved a resident. No statistically significant differences were found among the 2 groups in preoperative patient characteristics, including age, Society of Anesthesiologists score, prostate-specific antigen level, postvoid residual urine volume, International Prostate Symptom Score, or quality of life. The operative times were significantly longer in the resident group (57 vs 46 minutes, P = .05). Postoperatively, no differences in the mean values were found in postvoid residual urine volume (56 vs 64 mL, P = .73), change in International Prostate Symptom Score (11.5 vs 9.7, P = .44), change in quality of life score (-2.1 vs -1.3, P = .13), or reoperation rate (5% vs 11%, P = .19). CONCLUSION: The operative times were longer in the resident group, reflecting the inherent time taken to teach the residents the procedure. The results from the present study suggest that it is feasible to safely teach residents new surgical technology such as holmium laser ablation of the prostate in a nonacademic private practice setting without adversely affecting surgical performance or outcomes.
    Urology 01/2013; · 2.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The gold standard for symptomatic relief of bladder outlet obstruction secondary to benign prostatic hyperplasia has traditionally been a transurethral resection of the prostate (TURP). Over the past decade, however, novel laser technologies that rival the conventional TURP have multiplied. As part of the ongoing quest to minimize complications, shorten hospitalization, improve resection time, and most importantly reduce mortality, laser prostatectomy has continually evolved. Today, there are more variations of laser prostatectomy, each with several differing surgical techniques. Although abundant data are available confirming the safety and feasibility of the various laser systems, future randomized-controlled trials will be necessary to verify which technique is superior. In this review, we describe the most common modalities used to perform a laser prostatectomy, mainly, the holmium laser and the potassium-titanyl-phosphate lasers. We also highlight the physical and clinical characteristics of each technology with a review of the most current and highest-quality literature.
    Korean journal of urology 06/2013; 54(6):351-358.