Main Article Content
Background and Objective
In recent years, GreenLight laser photoselective vaporisation of the prostate (GL-PVP) has emerged as the primary ablative surgical treatment option for symptomatic bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPE). Unlike the reference procedure, monopolar-transurethral resection of the prostate (M-TURP), GL-PVP can be performed as a day case. As waiting list pressures continue to burden health boards across the UK, exacerbated by the COVID-19 pandemic, enhanced access to day case surgery to optimise patient flow is now of paramount importance. We evaluated the safety and feasibility of day case GL-PVP at our high-volume UK centre and identified predictors of a postoperative overnight stay.
Material and Methods
We performed a retrospective observational cohort study of all patients who underwent primary GL-PVP at a single institution between October 2016 and June 2021. All procedures were performed utilising the 180W GreenLight XPS™ laser therapy system. Various clinical, operative and functional data were collated, and outcomes were compared between patients who underwent day case surgery and those admitted overnight postoperatively.
In all, 538 patients underwent GL-PVP during the study period. Median patient age was 72 (interquartile range (IQR) 66–77), and median prostate volume was 62.5cc (IQR 45–90). Five hundred nineteen patients (96.5%) were discharged within 23 hours of admission, and 366 patients (68.0%) were managed as a true day case. Operative and functional outcomes were comparable between patients managed as a day case and those admitted overnight. There was higher patient-reported satisfaction and a lower rate of early hospital readmission in the day-case group. On univariate logistic regression analysis, patients aged ≥80 years (Odds Ratio 2.64 [95% Confidence Interval 1.65– 4.24], p = < 0.001), those with American Society of Anaesthesiologists (ASA) physical status classification score ≥3 (OR 1.92 [95% CI 1.33–2.78], p = < 0.001), those with prostate volume ≥80cc (OR 1.62 [95% CI 1.00–2.61], p = 0.05) and those in whom the operation time ≥60 minutes (OR 1.66 [95% CI 1.10–2.52], p = 0.02) were more likely to be admitted overnight following GL-PVP. On multivariate logistic regression analysis, age ≥80 (OR 2.64 [95% CI 1.47–4.73], p = 0.001) and ASA score ≥3 (OR 2.03 [95% CI 1.28–3.22], p = 0.003) remained predictive variables of an overnight stay.
From our observations of a large cohort of patients over a study period of almost five years, day case GL-PVP is a feasible concept and does not appear to compromise perioperative outcomes. With appropriate service redesign and optimisation of postoperative patient pathways, day case GL-PVP can be established in other centres and may have a role in alleviating waiting list pressures.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
2. Hashim H and Abrams P. Transurethral resection of the prostate for benign prostatic obstruction: will it remain the gold standard? Eur Urol 2015; 67(6):1097– 1098. doi: 10.1016/j.eururo.2014.12.022.
3. Thomas J, Tubaro A, Barber N. et al. A Multicenter Randomized Noninferiority Trial Comparing GreenLight-XPS Laser Vaporization of the Prostate and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: Two-yr Outcomes of the GOLIATH Study. Eur Urol 2016;69(1):94–102. doi: 10.1016/j.eururo.2015.07.054.
4. Zhou Y, Xue B, Mohammad N. et al. Greenlight high-performance system (HPS) 120-W laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a meta-analysis of the published results of randomized con-trolled trials. Lasers Med Sci 2016;31(3):485–495. doi: 10.1007/s10103-016-1895-x
5. Sandhu J, Ng C, Gonzalez R. et al. Photoselective Laser Vaporization Prostatectomy in Men Receiving Anticoagulants. J Endourol 2005;19(10), 1196-1198. doi: 10.1089/end.2005.19.1196.
6. Chung D, Wysock J, Lee R, et al. Outcomes and complications after 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia. J Urol 2011;186(3):977–981. doi: 10.1016/j.juro.2011.04.068.
7. Quemby D and Stocker M. Day surgery development and practice: key factors for a successful pathway. Contin Ed Anaesth Crit Care Pain 2014;14(6):256– 261. doi: 10.1093/bjaceaccp/mkt066.
8. Bain J, Kelly H, Snadden D, et al. Day surgery in Scotland: patient satisfaction and outcomes. Qual Safety Health Care 1999;8(2):86–91. doi: 10.1136/qshc.8.2.86.
9. National Health Service Department of Health. Day Surgery: Operational Guide, Waiting, Booking and Choice, August 2002. Available at: https://www.onedaysurgery.net/uploads/9/0/4/3/9043588/day_ surgery-_operational_guide.pdf.
10. NHS England: 2020/2021 National Tariff Payment System Annex D: Guidance on best practice tariffs) Available at: https://www.england.nhs.uk/wp-content/uploads/2021/02/20-21NT_Annex_D_Best_ practice_tariffs.pdf.
11. Boston Scientific. GreenLight XPS™ Laser Therapy System. 2021. Available at: https://www.bostonscientific. com/en-EU/products/lithotripsy/greenlight-xps. html.
12. Chen L, Mai H, Zhao L, et al. Experience of treating high risk prostate hyperplasia patients with a HPS120 laser. BMC Urol 2013;13(1). doi: 10.1186/1471-2490-13-64.
13. Woo H and West K. Does prostate size impact upon perioperative outcomes associated with photoselec-tive vaporization of the prostate using the 180W lithium triborate laser? Urol Annals 2015;7(1):17. doi: 10.4103/0974-7796.148579
14. Larner T, Agarwal D, and Costello A. Day-case holmium laser enucleation of the prostate for gland volumes of <60 mL: early experience. BJU Internat 2003;91(1):61– 64. doi: 10.1046/j.1464-410x.2003.03086.x.
15. Lee S, Gordon K, McMillan R. et al. Day-case holmium laser enucleation of the prostate: feasibility, safety and predictive factors. Ann Royal Coll Surg Engl 2018;100(6):475–79. doi: 10.1308/rcsann.2018.0039.
16. Klein C, Marquette T, Comat V, et al. Evolution of day-case holmium laser enucleation of the prostate success rate over time. J Endourol 2021;35(3):342–48. doi: 10.1089/end.2020.0337.
17. Audit Scotland: Day Surgery in Scotland – reviewing progress in 2004. Available at: https://www.audit- scotland.gov.uk/.
18. NHS England: 2019/2020 National Cost Collection for the NHS. Available at: https://www.england.nhs. uk/national-cost-collection/.