title: Rapid ambulatory pathway laser prostatectomy is safe: results within the global period.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. cullen.jumper@hitchcock.org
authors.forename: Cullen
authors.initials: C
authors.lastname: Jumper
authors.forename: Paul
authors.initials: P
authors.lastname: Snyder
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Yap
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects; D011470:Prostatic Hyperplasia / Q000601:surgery*