Is day-case prostatectomy feasible?

OBJECTIVE

To assess the possibility of discharging patients, catheter-free, on the same day that they undergo contact-laser prostatectomy.

PATIENTS AND

METHODS

Ten patients underwent contact vaporization of the prostate using the SLT (Surgical Laser Technologies, Oaks, PA, USA) Nd:YAG laser with an MTRL10 6 mm tip. Patients were selected in the out-patient clinic for day-case surgery on the basis of their good general health and clinically small glands. All patients had pre-operative urodynamic assessment and were proven obstructed and stable. Contact vaporization was carried out under general anaesthesia. Both intra-operative blood loss and irrigant absorption were assessed. The follow-up at 3 and 6 months included American Urological Association (AUA-7) symptom scores and the measurement of urinary flow rates.

RESULTS

The mean operating time was 25.2 min, with a mean application of 43.05 kJ of laser energy. The mean absorption of irrigant fluid was 30 mL and the mean intra-operative blood loss was 31 mL. Nine patients were discharged on the day of treatment. Two patients went into clot retention following discharge and had a suprapubic catheter sited, and two failed to void once discharged, necessitating catheterization for 2 weeks. At 3 and 6 months, there was a substantial decrease in the AUA symptom score and an improvement in urinary flow rate.

CONCLUSION

Day-case laser prostatectomy is possible, but the patients must be selected carefully and, perhaps more importantly, a specialist day-case anaesthetist must be available.