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Erazo J, Suso D, Sejnaui J, Aluma L, Mendoza L, Ramirez G, Morales C, Usubillaga F, Mendoza S, Rivera F, Mendoza A, Usubillaga MC, Erazo S, Chavarriaga J. Outpatient 180 W XPS GreenLight™ Laser Photoselective Vaporization of the Prostate: Seven Year Experience. J Endourol 2021; 36:548-553. [PMID: 34779677 DOI: 10.1089/end.2021.0618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE GreenLight XPS Laser System (GL-XPS) photoselective vaporization of the prostate (PVP) is not only non-inferior to Transurethral resection of the prostate (TURP), but with shorter rates of hospital stay and length of catheterization. Scarce literature has been published about the feasibility and safety of performing GL-XPS PVP in an outpatient setting. Our aim is to report our seven-year experience with outpatient GL-XPS PVP. METHODS Medical charts of all patients that underwent GL-XPS PVP between 2013 and 2020 were reviewed. Patients were discharged after careful monitoring in the recovery room and the catheter was removed either at home or at a schedule hospital visit. We used the Shapiro-Wilk test to assess for normal distribution, and the evaluation of homoscedasticity was performed with the SD Test. For qualitative variables, the comparison between groups was carried using the Chi-Square test and for the quantitative variables we used the non-parametric Mann Whitney U test. RESULTS A total of 537 patients were treated, 517 in an outpatient basis. Median age was 68 years (IQR 62-76), median prostate volume 50 cc (IQR 40-70). 22.8% were on anticoagulants or antiplatelet therapy. Median operative time was 100 minutes (IQR 75-125), length of hospital stay 5 hours (IQR 4-6.45), mean length of catheterization 48 hours (SD 14.92). Readmission rate within 90 days of surgery was 11.7%, 58 (10.8%) for surgical-related complications. Median time for readmission was 4 days (IQR 2-24). Immediate readmission (within 10 days) was recorded in 7.6% of patients, urinary retention was the main cause. No significant differences were found trying to find perioperative predictors for readmission. CONCLUSIONS Our experience suggests that outpatient GL-XPS PVP could be performed safely with a predefined outpatient pathway. With a low readmission and complication rate.
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Affiliation(s)
- Juan Erazo
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Daniel Suso
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Jorge Sejnaui
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Luis Aluma
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Lupi Mendoza
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - German Ramirez
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Carlos Morales
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | | | - Sergio Mendoza
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Fabio Rivera
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Alexandra Mendoza
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Maria C Usubillaga
- Pontificia Universidad Javeriana Facultad de Medicina, 89654, Urology, Bogota, Colombia;
| | - Santiago Erazo
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Julian Chavarriaga
- Pontificia Universidad Javeriana Facultad de Medicina, 89654, Urology, Bogota, Colombia.,Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
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Gury L, Robert G, Bensadoun H. [Where do we stand with benign prostatic hyperplasia day-case surgery: A laser effect?]. Prog Urol 2018; 28:509-514. [PMID: 29907496 DOI: 10.1016/j.purol.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/18/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES Despite its feasibility has been proven, Benign Prostatic Hyperplasia (BPH) day-case surgery remains uncommon. Our objective was to describe the evolution of BPH day-case surgery in France according to the surgical technique employed. MATERIALS AND METHODS We extracted data from the Information System of Medicalization Program (PMSI) including all of the hospital stays in France from 2010 to 2016. Patients belonging to the transurethral prostatectomy homogeneous group of patients (GHM 12C04) and having as a main diagnosis prostatic hyperplasia (N40) or benign prostatic tumor (D291) were included in the analysis. From March 2016, specific codes were introduced to differentiate laser surgery and other types of surgery: JGFE023 (resection without laser), JGFE365 (laser resection) and JGNE171 (laser vaporization). We described the rates of day case surgery and the average length of stay from 2010 to 2016. From March 2016 we could study the influence of laser surgery on day-case and length of stay. RESULTS Regarding the all dataset analysis we found 328,781 hospital stays (318,549 patients) for BPH surgery, of which 2.7% (9047 hospital stays) were day-case. From 2010 to 2016, the lengths of stay decreased from 5.78 to 4.29 days. In the meantime, the number of day-case procedures increased from 14 patients (0.03%) to 3035 patients (5.63%). Regarding the last 9 months of 2016, we found 38,930 hospital stays including 5.4% (2104) day-cases. In total, 92.7% of day-case procedures had been performed with a laser technique, of which 47.9% (1008) were laser vaporization and 44.8% (944) were laser resection. There were only 7.1% (151.8%) of day-case procedures performed without laser. CONCLUSION The exponential development of the day-case procedures seems to be linked with the advent of laser technology. This tendency is expected to increase in the coming years according to the spreading of laser surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- L Gury
- Service d'urologie, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France.
| | - G Robert
- Service d'urologie, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France
| | - H Bensadoun
- Service d'urologie, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France
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Bruyère F. [Comment on "Introduction of the photoselective vaporization of the prostate in an outpatient setting: Outcomes after the first 100 cases"]. Prog Urol 2016; 26:668-669. [PMID: 27712913 DOI: 10.1016/j.purol.2016.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/14/2016] [Indexed: 11/25/2022]
Affiliation(s)
- F Bruyère
- Service d'urologie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France; Université François-Rabelais de Tours, Centre Val-de-Loire université, 37000 Tours, France.
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