Day-case holmium laser enucleation of the prostate for gland volumes of < 60 ml: early experience



I read with interest this article [1] reporting holmium laser resection of the prostate as day surgery. In 1998 I reported a series of conventional TURPs carried out as day surgery [2] in which 58 patients were assessed. The mean duration of catheterization was 7.69 h for patients with spinal anaesthesia and 3.86 h with general anaesthesia. All patients were discharged within 14 h of admission. Forty-eight patients were discharged home catheter-free and 10 (17%) required re-insertion of a catheter for urinary retention. One patient had a small clot of 10 mL causing urinary retention. One patient was admitted to a private hospital for disseminated intravascular coagulation secondary to previously undiagnosed carcinoma of prostate and was discharged home 5 days after surgery with no further complications. A further patient was admitted to the private hospital for management of fever and was discharged home 48 h after surgery. Five of the patients who were catheterized after TURP were discharged home overnight and readmitted the following day to remove the catheter and attempt voiding; all were successful.

The patients, when questioned at a review, were satisfied with the short stay, treatment and facilities. Those most satisfied were self-employed, particularly sole income earners, who desired an early return to employment.

The use of conventional electrocautery in TURP for day surgery was considerably cheaper, particularly considering the low cost of capital equipment. With the availability of conventional resectoscopes and standard diathermy this procedure is well within the realms of the expertise of the practising specialist urologist.