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EAU 2018: Day-case Transurethral Resection of the Prostate (TURP) is Possible for Three-quarters of Men

Copenhagen, Denmark (UroToday.com) Transurethral resection of the prostate (TURP) remains one of the most common and efficacious procedures for the treatment of benign prostatic hyperplasia or benign prostatic obstruction. However, many patients view the TURP as a highly invasive procedure with a plethora of side effects such as erectile dysfunction and negative impacts of retrograde ejaculation. Novel BPH procedures aim to alleviate these concerns, but there have been few attempts to perform the TURP as an outpatient procedure in effort to relieve patient concerns.

Dr. Kyriazis from the Portsmouth Hospitals Department of Urology in Portsmouth, United Kingdom presents a single-center experience of the TURP performed as a single-day / outpatient procedure. Patient outcomes such as re-admission occurrences within 30 days, transfusion rates, weight of resected tissue and operating times were analyzed retrospectively from 2011-2016.

In this five year period, a total of 1038 procedures were performed, of which 692 (66%) were planned to be outpatient procedures. In addition to these planned procedures, however, an additional 58 cases which were originally planned for inpatient care were sent home the same day of surgery. After consideration of these cross-over events, there were a total of 573 patients who were actually discharged within the same day of surgery post-TURP.

Overall, the patients who were discharged the same day were younger (70.7 years vs. 73.7 years), had a shorter operative time (36.8 minutes vs. 47.5 minutes), and had a lower resected tissue weight (10.1 grams vs. 15.7 grams) in comparison to those undergoing inpatient TURP.

Of note, since this study began, adaptations in the clinical care pathway at this institution has allowed for a steady increase in the absolute number (and proportion) of TURP procedures performed as an outpatient case (48.7% in 2011 vs. 75.9% in 2016, P<0.05). Additionally, there has been a decrease in the number of cases scheduled as outpatient converting to inpatient.

In discussion, Dr. Kyriazis noted the following adaptations in the clinical care pathway which aided in same-day discharges; for example, careful patient selection, management of patient expectations, soft 3-way catheter placement, and careful patient counseling via a “consultant of the week” service. Because of these adaptations and a well-trained nursing staff, Dr. Kyriazis asserts that TURP can be feasibly scheduled as a routine, outpatient procedure.

Authors: Kyriazis G., Mbiadjeu D., Lavan L., Austin T., Gormley R., Hodgson D.

Written by: Linda M. Huynh, B.S., University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark