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Preoperative and Perioperative Predictors of Adverse Clinical Outcomes after Thulium Fiber Laser Enucleation of the Prostate
Daniel Sanford, MD, Jarrett Noakes, BS, Jack Mulcrone, BA, Raymond Chiang, BS ScM, Andrew Tompkins, MD, Samuel Eaton, MD.
Brown University Health, Providence, RI, USA.
BACKGROUND: Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) is an established procedure for men with enlarged prostates. Post-operative complications include hematuria requiring continuous bladder irrigation (CBI), urinary retention, and urinary tract infection (UTI). We studied pre-operative and intraoperative risk factors that may be predictive of these adverse outcomes.
METHODS: Demographic, pre-operative, and peri-operative variables were abstracted for 250 consecutive ThuFLEP cases. Univariable and multivariable regression models were used to predict 30-day post-operative complications including UTI, hematuria requiring CBI with hospital admission, and post-operative urinary retention.
RESULTS: On univariable analysis, positive pre-op urine culture (RR 1.77, 95% CI 1.02-3.07) and pre-operative urinary retention requiring indwelling foley catheter or intermittent catheterization (CIC) (RR 2.01, 95% CI 1.08-3.72) were associated with higher post-operative UTI risk. Use of CBI post-operatively trended toward increased risk of UTI (RR 1.70, 95% CI = 0.94-3.16). On multivariable analysis (table 1B), active smoking independently predicted UTI (OR 5.98, 95% CI 1.01-35.18, p=0.048). Pre-operative factors that were associated with post-operative hematuria requiring CBI and hospital admission included higher comorbidity burden (OR 1.6, 95% CI 1.3-2.81, p=0.003) while larger prostate size saw a trend toward significance (OR 1.01, 95% CI 0.99-1.02, p=0.08). No pre-operative factors were associated with post-operative urinary retention.
CONCLUSIONS:Patients with greater co-morbidity had an increased risk of hospital admission due to hematuria while patients with a larger prostate gland saw a trend toward an increased risk of hospital admission from hematuria. Patients with positive pre-operative urine culture and retention requiring indwelling foley catheter or CIC had an increased risk of post-operative UTI. These findings can aid in pre-operative counseling and may help identify those in need of more aggressive interventions post-operatively.
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