Is day-case surgery feasible for laser endoscopic enucleation of the prostate? A systematic review.

PURPOSE: Laser endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction has become increasingly prevalent worldwide. Considering the medical cost-savings and concomitantly fewer nosocomial infections, the feasibility of same-day postoperative discharge of patients who have undergone laser EEP in terms of its safety and effectiveness has become a subject matter of growing interest. We aimed to review those studies focussing on day-case surgery (DCS) in patients undergoing laser EEP. METHODS: A systematic search was conducted using PubMed-MEDLINE and Web of Science databases until October 2022 with the following search terms: "same day discharge AND laser enucleation of the prostate", "day-case AND laser enucleation of the prostate", "same day surgery AND laser enucleation of the prostate" and "one day surgery AND laser enucleation of the prostate" by combining PICO (population, intervention, comparison, outcome) terms. We identified 15 eligible studies. RESULTS: While 14 of the studies focussed on holmium laser EEP, one focused on thulium laser vapoenucleation of the prostate. We observed an improvement in functional parameters in all studies we reviewed, and DCS success and readmission rates ranged between 35.3-100% and 0-17.8%, respectively. The complication rates varied between 0 and 36.7%, most of the complicatons were Clavien-Dindo (CD) I and II. CD ≥ III complications did not significantly differ between same day discharge (SDD) and non-SDD groups in the studies. CONCLUSION: Laser EEP is feasible and promising DCS treatment option delivering improved functional parameters compared to baseline values, and lower perioperative complication and readmission rates in certain patients.

Comparison of the Efficacy of Holmium Laser Enucleation of the Prostate in Treating Prostate Volumes of ≤80 and > 80 mL.

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) is becoming the new standard procedure for treating benign prostatic hyperplasia (BPH), a common condition in aging men. Most studies have focused on proving its efficacy in treating large prostates. In this study, we compared its efficacy in treating small (< 80 mL) and large (> 80 mL) prostates. METHODS: This prospective study included 119 patients with BPH who underwent HoLEP by the same surgeon between June 2015 and December 2017. They were divided into 2 groups according to their prostate volumes (≤80 mL: Group 1; > 80 mL: Group 2). Various pre- and postoperative parameters were compared within and between the groups. RESULTS: International Prostate Symptom Score (IPSS), postvoid residual (PVR) volume, and voiding time (VT) significantly decreased, and the peak urinary flow rate (Qmax), average urinary flow rate (Qave), and quality of life (QoL) score significantly increased postoperatively in both groups. The postoperative changes in IPSS, QoL score, Qmax, Qave, VT, PVR volume, and hemoglobin levels were not significantly different between the groups. In addition, no significant difference was observed in postoperative complications between the groups. CONCLUSIONS: Our results indicate that HoLEP is an effective procedure for treating both small and large prostates.

Prostate shape significantly affects the HoLEP procedure time and energy usage: A retrospective pilot study.

Introduction: In this study we evaluate the influence of longitudinal and transverse length of prostate size measured on the magnetic resonance imaging (MRI) scan on the overall outcomes of HoLEP. Material and methods: The patients were divided into two groups based on the shape of the prostate. Group 1 had a longitudinal shape with a longitudinal diameter greater than the transverse diameter, whereas group 2 had an oval shape with a transverse diameter greater than the longitudinal diameter. The pre-operative, peri-operative and the one-month post-operative data along with the urinary parameters were then evaluated. Results: The two groups were comparable with regard to their pre-operative values. While the median lobe enucleation time and morcellation time showed no difference, group 1 showed a significantly shorter (p < 0.01) operative time for lateral lobe enucleation, lower laser energy usage and better enucleation efficiency. However, there was no difference in the median lobe enucleation time, morcellation time, haemoglobin drop, duration of urethral catheterization and hospital stay. The groups were also comparable with regard to the improvement in urinary parameters and complications. Conclusion: Prostate shape plays a significant role in the surgical treatment of BPH.