2167 LASER PROSTATECTOMY IN THE SEVERELY ILL - OUTCOMES AND FEASIBILITY OF A RAPID AMBULATORY DISCHARGE PATHWAY

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (III)1 Apr 20132167 LASER PROSTATECTOMY IN THE SEVERELY ILL - OUTCOMES AND FEASIBILITY OF A RAPID AMBULATORY DISCHARGE PATHWAY Benjamin Herrick, Johann Ingimarsson, and Ronald Yap Benjamin HerrickBenjamin Herrick Lebanon, NH More articles by this author , Johann IngimarssonJohann Ingimarsson Lebanon, NH More articles by this author , and Ronald YapRonald Yap Concord, NH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2076AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laser prostate surgery is increasingly being used to treat BPH while potentially decreasing morbidity compared to standard electrosurgical resection. However, little is known in the urologic literature regarding the outcomes or feasibility of an ambulatory discharge pathway in high anesthetic risk patients who have undergone such procedures. METHODS A retrospective chart review was performed on patients undergoing holmium laser ablation of the prostate (HoLAP) between 2007 and 2011 by a single surgeon. Using the American Society of Anesthesiologists (ASA) physical status classification system, all patients with category 3 (“severe systemic disease”) or higher were included in this study. Patients were placed on a rapid ambulatory discharge pathway (RAD), discharged on the day of surgery with a urethral catheter in place with a voiding trial on post-operative day 3. Patients with less than 90 days of follow-up and patients that were planned post-operative admission were excluded. Preoperative, intraoperative, and postoperative outcomes and complications were analyzed using two-tailed Student t-tests (p <0.05). All complications within 90 days of surgery were included in the analysis. RESULTS 41 patients met inclusion criteria. Mean follow-up was 142 days. Average preoperative AUA symptom score (AUA-SS) and Quality of Life (QoL) scores were 20.4 and 3.5. Average prostate volume was 37 grams (range 20-100). The mean change in post-operative AUA-SS and QoL were -9.1 (p<0.05) and -1.1 (p<0.05). 33 patients (80%) remained on the RAD. Six patients (15%) were admitted: hematuria (3), urinary retention (1), CHF exacerbation (1), MI (1). Two patients (5%) visited the Emergency Department regarding catheter problems and were subsequently discharged. There was one death unrelated to surgery (passenger in a motor vehicle crash). CONCLUSIONS This series suggests that it is feasible and safe to perform ambulatory laser ablation prostate surgery on high anesthetic risk patients with small to medium size prostates. Even in patients with severe systemic illness (ASA 3 or 4) 80% of them successfully remained on the pathway and were discharged on the day of surgery. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e888 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Herrick Lebanon, NH More articles by this author Johann Ingimarsson Lebanon, NH More articles by this author Ronald Yap Concord, NH More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...