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Laser Prostatectomy in the Severely Ill - Outcomes and Feasibility of a Rapid Ambulatory Discharge Pathway
Benjamin W. Herrick, M.D.1, Jane Wells, M.S.2, Ronald L. Yap, M.D.3.
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2Concord Hospital, Concord, NH, USA, 3Concord Hospital, Center for Urologic Care, Concord, NH, USA.

Introduction: Laser prostatectomy is increasingly being used in the treatment of BPH related lower urinary tract symptoms (LUTS) while potentially decreasing morbidity compared to standard electrosurgical resection. However, little is known 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 2010 by a single surgeon. Using the American Society of Anesthesiologists (ASA) physical status classification system, all patients with category 3 ("severe systemic disease") were included in this study. Patients with less than 180 days of follow-up were excluded. 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. Preoperative, intraoperative, and postoperative outcomes and complications were analyzed using two-tailed Student t-tests (p <0.05).
Results: 26 cases were included in this study. Mean follow-up was 484 days. Average preoperative AUA symptom score (AUA-SS) and Quality of Life (QoL) scores were 20.80 and 3.41. The mean change in post-operative AUA-SS and QoL were -10.59 (p<0.001) and -1.51 (p=0.01). 21 (80%) of patients stayed on the RAD, 2(8%) were admitted for 23-hour observation, and 3 (11%) were admitted as inpatients. There were no post-operative blood transfusions, myocardial infarctions, or deaths.
Conclusion: It is safe to employ a rapid ambulatory discharge pathway for laser prostatectomy in high-risk patients with good short to intermediate term outcomes.


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