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Pandolfo SD, Del Giudice F, Chung BI, Manfredi C, De Sio M, Damiano R, Cherullo EE, De Nunzio C, Cacciamani GE, Cindolo L, Porpiglia F, Mirone V, Imbimbo C, Autorino R, Crocerossa F. Robotic assisted simple prostatectomy versus other treatment modalities for large benign prostatic hyperplasia: a systematic review and meta-analysis of over 6500 cases. Prostate Cancer Prostatic Dis 2023; 26:495-510. [PMID: 36402815 DOI: 10.1038/s41391-022-00616-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused by large prostate glands. We aimed to provide a wide-ranging analysis of the currently available evidence, comparing safety and effectiveness of robot-assisted simple prostatectomy (RASP) versus open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and laser EEP. METHODS A systematic search was performed across MEDLINE, EMBASE, and Web of Science databases for retrospective and prospective studies comparing RASP to OSP or LSP or laser EEP (HoLEP/ThuLEP). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design the search strategies, selection criteria, and evidence report. A meta-analysis evaluated perioperative safety and effectiveness outcomes. The weighted mean difference and risk ratio were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for RCT article assessing risk of bias. RESULTS 15 studies, including 6659 patients, were selected for meta-analysis: 13 observational studies, 1 non-randomized prospective study, and 1 randomized controlled trial. RASP was associated with statistically significant longer operative time (OT) and lower postoperative complication rate, length of stay (LOS), estimated blood loss (EBL), and transfusion rate (TR) compared to OSP. LSP showed longer LOS and lower postoperative SHIM score, with no difference in OT, EBL, and complications. Compared to laser EEP, RASP presented longer LOS and catheterization time and higher TR. ThuLEP presented shorter OT than RASP. No difference were found in functional outcomes between groups both subjectively (IPSS, QoL) and objectively (Qmax, PVR). CONCLUSION RASP has become a size-independent treatment for the management of BPO caused by a large prostate gland. It can duplicate the functional outcomes of OSP while offering a better safety profile. When compared to LSP, the latter still stands as a valid lower-cost option, but it requires solid laparoscopic skill sets and therefore it is unlikely to spread on larger scale. When compared to laser EEP, RASP offers a shorter learning curve, but it still suffers from longer catheterization time and LOS.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
- Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Benjamin I Chung
- Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Damiano
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Cosimo De Nunzio
- Urology Unit, Ospedale Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luca Cindolo
- Department of Urology, Villa Stuart, Private Hospital, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA.
| | - Fabio Crocerossa
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Pathak RA, Krol BC, Crain NA, Hemal AK. Robot-Assisted Simple Prostatectomy: A Comparison of Primary Simple Prostatectomy Versus Salvage Simple Prostatectomy in Treatment of Lower Urinary Tract Symptoms. J Endourol 2023; 37:414-421. [PMID: 36680760 DOI: 10.1089/end.2022.0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Simple prostatectomy is indicated in patients with enlarged glands (>80 g) who present with lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia. Salvage robotic simple prostatectomy (SSP) is defined as simple prostatectomy after failed transurethral procedure. The aim of this study is to evaluate the efficacy of primary robotic simple prostatectomy (PSP) vs SSP in ameliorating LUTS. Materials and Methods: We retrospectively reviewed 124 patients who underwent RSP between 2013 and 2021. Indications for surgery were enlarged prostate, bothersome LUTS, or symptoms refractory to medical management and/or previous prostate surgery. PSP and SSP preoperative, perioperative, and postoperative variables were recorded. The severity of LUTS was assessed using the International Prostate Symptoms Score (IPSS). Two-tailed t-tests were performed to compare primary vs salvage RSP cohorts at a p-value of 0.05. Results: Of 124 patients who underwent RSP, 98 were primary and 26 were in the salvage setting with 19 patients undergoing prior transurethral resection of the prostate, 3 status post-transurethral microwave therapy, 1 status post-transurethral needle ablation of the prostate, and 3 status post-UroLIFT. Mean length of stay following RSP was 1.87 (days). At mean follow-up of ∼12 months, no patient required reoperation for LUTS. Preoperative IPSS for primary and salvage RSP was 18.56 and 16.25, respectively (p = 0.36), and postoperative IPSS for primary and salvage RSP was 5.33 and 8.00, respectively (p = 0.38). Conclusion: Regardless of primary or salvage indication, RSP remains a highly efficient and durable procedure for improvement in LUTS. RSP performed in the salvage setting greatly improved urinary function outcomes in patients after failure of previous transurethral procedures.
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Affiliation(s)
- Ram A Pathak
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Bridget C Krol
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nikhil A Crain
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ashok K Hemal
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
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Hawken SR, French W, Kay H, Scales CD, Viprakasit DP, Friedlander DF. Comparison of Cost and Perioperative Outcomes Among Patients Undergoing Simple Prostatectomy and Laser Enucleation of the Prostate. J Endourol 2023; 37:60-66. [PMID: 36193580 DOI: 10.1089/end.2022.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction: Simple prostatectomy (SP) and laser enucleation of the prostate (LEP) are treatments for symptomatic benign prostatic hyperplasia (BPH) in men with large glands (e.g., >80 g). The decision between the two operations is often dependent on surgeon preference/experience and equipment availability. As the use of minimally invasive techniques, such as robotic-assisted simple prostatectomy, has increased for the treatment of large gland BPH, studies comparing the outcomes and cost of these modalities in a contemporary cohort are lacking. Methods: All-payer data from Healthcare Cost and Utilization Project State Databases from Florida, New York, California, and Maryland from 2016 to 2018 were used to identify adults who underwent SP or LEP for BPH. Patient demographics, facility characteristics, revisit rates, and cost of the index hospitalization were examined. Multivariable logistic and gamma generalized linear regression models were utilized to compare predictors of the operation performed, 30-day revisits, and index hospitalization cost among the two operations. Results: Of the 2032 patients in the cohort, 1067 (46.4%) underwent LEP and 965 (41.9%) underwent SP. On multivariable logistic regression analysis, SP patients were younger, had higher comorbidity scores, and were more likely to be uninsured compared with LEP patients. Thirty-day revisit rates among the operations were equivalent (odds ratio 0.89, 95% confidence interval 0.63-1.27, p = 0.05). The mean adjusted cost of the index hospital stay for LEP was significantly greater than that of SP ($7291 vs $6442, p = 0.04). However, our sub-group analysis examining high-volume centers revealed no significant differences in cost ($6184 vs $5353, p = 0.1). Conclusions: Across the four states examined, SP and LEP were performed with comparable volume and had similar rates of 30-day revisits. The SP was less expensive than LEP overall; however, among high-volume facilities, the cost of both operations was reduced, such that they were equivalent.
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Affiliation(s)
- Scott R Hawken
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - William French
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Hannah Kay
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Charles D Scales
- Department of Urology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Davis P Viprakasit
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - David F Friedlander
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Impact of diverticular disease on prostate cancer risk among hypertensive men. Prostate Cancer Prostatic Dis 2022; 25:700-706. [PMID: 34621012 DOI: 10.1038/s41391-021-00454-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Prostate cancer (PCa) is a heterogenous disease with multiple etiological factors playing a role in its development. Recently, chronic and systemic inflammatory conditions such as inflammatory bowel disease were identified as key risk factors influencing its development. The study aimed to evaluate the relationship between diverticular disease (DD) (local and acute inflammation) and PCa. METHODS Hypertensive patients with DD and hypertensive controls were identified between 1995 and 2010 from the Statewide Planning and Research Cooperative System database. Cohorts were queried for PCa incidence through 2015. Univariable and multivariable logistic regression analyses were used for determining independent predictors of PCa diagnosis. RESULTS A total of 51,353 patients with DD and 111,541 controls were identified. In all, 6.26% of DD developed PCa, and 3.71% of controls developed PCa (p < 0.01). DD was a significant risk factor for PCa (OR: 1.27 CI: 1.19-1.34, p < 0.01). On subgroup analysis, the patients diagnosed with DD <50 years old had an OR of 3.39 for PCa (CI: 2.52-4.56, p < 0.01), age 50-59 had an OR of 2.12 (CI: 1.86-2.15, p < 0.01), and age 60-69 had an OR of 1.20 (CI: 1.10-1.31, p < 0.01). Finally, age and race stratification showed that white patients <50 had an OR of 2.56 (CI: 1.75-3.76, p < 0.01), while black patients <50 had an OR of 3.98 (CI: 2.61-6.07, p < 0.01). The trend in differing odds between these populations was the same for age groups 50-59 and 60-69. CONCLUSION Our analysis shows that DD is associated with diagnosis of PCa in hypertensive men. Importantly, the earlier the diagnosis of DD, the higher the odds for development of PCa, particularly in black men.
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Scarcella S, Castellani D, Gauhar V, Teoh JYC, Giulioni C, Piazza P, Bravi CA, De Groote R, De Naeyer G, Puliatti S, Galosi AB, Mottrie A. Robotic-assisted versus open simple prostatectomy: Results from a systematic review and meta-analysis of comparative studies. Investig Clin Urol 2021; 62:631-640. [PMID: 34729963 PMCID: PMC8566792 DOI: 10.4111/icu.20210297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To review safety and efficacy of robotic-assisted simple prostatectomy (RASP) compared to open simple prostatectomy (OP). MATERIALS AND METHODS A comprehensive literature search was performed to assess the differences in perioperative course and functional outcomes in patients with benign prostatic hyperplasia and surgical indication. The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method and expressed as odds ratio (OR), 95% confidence interval (CI), and p-values. Perioperative course and functional outcomes were pooled using the inverse variance of the mean difference (MD), 95% CI, and p-values. Analyses were two-tailed and the significance was set at p<0.05. RESULTS Eight studies were accepted. Meta-analysis showed significantly longer surgical time (MD, 43.72; 95% CI, 30.57-56.88; p<0.00001) with a significantly lower estimated blood loss (MD, -563.20; 95% CI, -739.95 to -386.46; p<0.00001) and shorter postoperative stay (MD, -2.85; 95% CI, -3.72 to -1.99; p<0.00001) in RASP. Catheterization time did not differ (MD, 0.65; 95% CI, -2.17 to 3.48; p=0.65). The risk of blood transfusion was significantly higher in OP (OR, 0.23; 95% CI, 0.17-0.33; p<0.00001). The risk of recatheterization (OR, 1.96; 95% CI, 0.32-11.93; p=0.47), postoperative urinary infections (OR, 0.89; 95% CI, 0.23-3.51; p=0.87) and 30-day readmission rate (OR, 0.96; 95% CI, 0.61-1.51; p=0.86) did not differ. At 3-month follow-up, functional outcomes were similar. CONCLUSIONS RASP demonstrated a better perioperative outcome and equal early functional outcomes as compared to OP. These findings should be balanced against the longer operative time and higher cost of robotic surgery.
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Affiliation(s)
- Simone Scarcella
- Urology Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti di Ancona", Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti di Ancona", Università Politecnica delle Marche, Ancona, Italy.
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Jurong East, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Carlo Giulioni
- Urology Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti di Ancona", Università Politecnica delle Marche, Ancona, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
- ORSI Academy, Melle, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti di Ancona", Università Politecnica delle Marche, Ancona, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
- ORSI Academy, Melle, Belgium
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Xia Z, Li J, Yang X, Jing H, Niu C, Li X, Li Y, Zhang Z, Wu J. Robotic-Assisted vs. Open Simple Prostatectomy for Large Prostates: A Meta-Analysis. Front Surg 2021; 8:695318. [PMID: 34355017 PMCID: PMC8330838 DOI: 10.3389/fsurg.2021.695318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/28/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose: To compare the efficacy and safety of robotic-assisted simple prostatectomy and open simple prostatectomy for large benign prostatic hyperplasia. Methods: We systematically searched the Cochrane Library, PubMed, Embase, and Science databases for studies published through December 2020. Controlled trials on RASP and OSP for large prostates were included. The meta-analysis was conducted with the Review Manager 5.4 software. Results: A total of seven studies with 3,777 patients were included in the analysis. There were no significant differences in IPSS (WMD, 0.72; 95%CI: -0.31, 1.76; P = 0.17), QoL (WMD, 0.00; 95%CI: -0.39, 0.39; P > 0.99), Qmax (WMD, 1.88; 95% CI: -1.15, 4.91; P = 0.22), or PVR (WMD, -10.48; 95%CI: -25.13, 4.17; P = 0.16) among patients undergoing RASP and OSP. However, compared with patients who underwent OSP, patients who underwent RASP had a shorter LOS (WMD, -2.83; 95%CI: -3.68, -1.98; P < 0.001), less EBL (WMD, -304.68; 95% CI: -432.91, -176.44; P < 0.001), a shorter CT (WMD, -2.61; 95%CI: -3.94, -1.29; P < 0.001), and fewer overall complications (OR, 0.30; 95% CI: 0.16, 0.57; P < 0.001). Nevertheless, RASP was associated with a longer OT (WMD, 59.69, 95% CI: 49.40, 69.98; P < 0.001). Conclusion: The results of the current study demonstrated that RASP provided similar efficacy to those of OSP in the treatment of large prostate, while maintaining better security. Our findings indicate that RASP is a feasible and effective alternative to OSP.
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Affiliation(s)
- Zhongyou Xia
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiaoying Yang
- Blood Purification Center of Department of Nephrology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, China
| | - Hao Jing
- Department of Urology, Pidu District People's Hospital, Chengdu, China
| | - Chao Niu
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, China
| | - Xianhui Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, China
| | - Zongping Zhang
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, China
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, China
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Assmus MA, Large T, Lee MS, Agarwal DK, Rivera ME, Krambeck AE. Same-Day Discharge Following Holmium Laser Enucleation in Patients Assessed to Have Large Gland Prostates (≥175 cc). J Endourol 2021; 35:1386-1392. [PMID: 33567989 DOI: 10.1089/end.2020.1218] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Holmium laser enucleation of the prostate (HoLEP) is a highly effective and durable minimally invasive surgery for benign prostatic hyperplasia. Historically, alternative treatments for large glands (≥175 cc) are associated with prolonged length of stay (LOS) and postoperative catheterization. However, advances in laser technology combined with surgical technique optimization have early evidence supporting same-day discharge. We look to examine contemporary same-day discharge outcomes for large glands. Materials and Methods: With Institutional Review Board (IRB) approval we queried our electronic medical record and retrospective clinical registry to examine perioperative outcomes of large gland (≥175 cc) prostates that underwent HoLEP with consideration for same-day discharge. Results: From December 10, 2019 to September 29, 2020 we identified 55 patients with a preoperative prostate size ≥175 cc (39 CT, 12 MRI, 4 transrectal ultrasound), of which 45 were scheduled for same-day discharge and 10 for admission. Mean preoperative prostate size was 229.9 cc (range 175-535 cc) and 36 (65.5%) were in urinary retention. Mean preoperative prostate-specific antigen (PSA) was 8.58 ng/mL, American Urological Association Symptom Score (AUASS) 22.3, and Qmax 8.8 mL/second. At 3 months postoperative follow-up mean AUASS was 6.7, PSA 0.87 ng/mL and Qmax 20.4 mL/second. All comer same-day discharge rate was 70% (38/55). Of patients planned for same-day discharge 38/45 (84%) were effective. Average LOS for all patients was 11.8 hours with catheterization of 21.2 hours. When compared with 2010 published large gland outcomes, our current LOS represents a 220% reduction. Looking specifically at patients planned for same-day discharge, average LOS and catheter duration was 8.8 and 17.0 hours, whereas LOS and catheter duration for patients planned for admission was 25.7 and 39.4 hours, respectively. Conclusions: We report the first outcomes of preoperatively planned same-day discharge for HoLEP in large glands (≥175 cc). A combination of technologic advances and optimization of technique have allowed for a safe adoption of same-day discharge, providing additional advantages over alternative large gland treatments.
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Affiliation(s)
- Mark A Assmus
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Matthew S Lee
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Deepak K Agarwal
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marcelino E Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy E Krambeck
- Department of Urology, Northwestern University, Chicago, Illinois, USA
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