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Greenlight Laser Prostatectomy: A safe and effective day case option for bladder outlet obstruction in the elderly population

Gordon Weight1, Hermione Tsoi1, Patrick Cutinha1, Sanjay Rajpal2


1STH, Sheffield, United Kingdom. 2Airedale NHS Trust, Bradford, United Kingdom


Abstract


Aim: Greenlight-laser prostatectomy (GLLP) is becoming a popular treatment option for bladder outlet obstruction and lower urinary tract symptoms (LUTS). In this retrospective study, we aim to explore the patient and perioperative factors associated with successful day-case outcome following GLLP.


Methods: Patients who underwent GLLP at a UK tertiary centre between June 2018 and November 2021 were included in this study. Retrospective data covering patient demographics, perioperative parameters and postoperative outcomes were collected using the electronic records systems.


Results: 305 patients were included in this study with a median age of 74. The most common indication (62.6%) for the procedure was patient’s wish to be free from long-term or intermittent catheters, followed by failed medical therapy (36.4%). 84.6% of patients had an ASA ≥2, and 32.1% took anticoagulant or antiplatelet therapy.
64.2% of patients were performed as day case, and only 10.5% of patients requiring more than a single night admission. Day case surgery was feasible in all patient groups, but patient comorbidity had a significant impact on day-case rate (ASA 1 = 83.3%, ASA 2 = 67.7%, ASA 3 = 43.6%, p=0.0003).
The 3-month readmission rate was 10.8%. 91.2% of patients were catheter-free at follow up.


Conclusions: Our study shows that GLLP should be performed as a day-case procedure for all patients unless specific patient factors mandate otherwise. Patient comorbidity has a significant impact on day-case success for GLLP.
It is suitable for elderly and comorbid patients with appropriate patient optimisation and robust pre & peri-operative pathways.