Day-Case Holmium Laser Enucleation of the Prostate: Prospective Evaluation of 90 Consecutive Cases

Purpose: To prospectively assess the feasibility and safety of holmium laser enucleation of the prostate (HoLEP) as day-case surgery for the treatment of benign prostatic hyperplasia. Materials and Methods: A prospective observational study was conducted by a single surgeon between June 2012 and October 2015. Except for patients ineligible for day-case surgery due to unstable cardiovascular disease, all patients with lower urinary tract symptoms presumably due to benign prostatic hyperplasia were consecutively included. HoLEP procedures were performed at 8AM, and patients were discharged before 8PM. The urinary catheter was removed at home the following morning. The monitoring of complications related with surgery included systematic assessment of perioperative complications, phone call within 48 hours after surgery, and follow-up visits after 1 and 3 months. Intent-to-treat univariate and multivariate analysis was performed to identify risk factors for day-case surgery failure. Results: Ninety among 211 HoLEP performed by the surgeon were selected for day-case surgery (43%). Hospital stay was <12 hours in 83.4% of them. Prolonged hospitalization was necessary in 15 patients mainly due to gross hematuria requiring continuous bladder irrigation (n = 13). Day-case surgery failure rate (including prolonged hospitalization and readmissions within 48 hours) was 20.0% (18/90). The overall complication rate was 36.7%, with a Clavien III complication rate of only 3.3%. Monocentric design and limited number of patients are the main limitations of this work. Conclusions: This prospective evaluation shows that day-case HoLEP may be performed by a trained surgeon with an appropriate patient selection.