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Introduction: The effect of prophylactic bladder neck incision (BNI) at time of holmium laser enucleation of the prostate (HoLEP) is unknown. The aim of our study was to examine HoLEP outcomes with a specific focus on rates of bladder neck contractures (BNCs), with and without utilizing prophylactic BNI. Materials and Methods: We performed a retrospective review of HoLEP patients from January 2021 until January 2022. Outcomes of patients who underwent BNI at time of HoLEP were compared with those who underwent standard HoLEP alone. Student's t-tests, chi-square tests, and logistic regressions were performed using SAS Studio. Results: In total, 421 patients underwent HoLEP. BNI was concurrently performed in 74 (17.6%) HoLEP patients. BNI patients were younger (67.5 ± 9.0 years vs 71.1 ± 8.2 years, p = 0.00007) and had smaller prostates (60.7 ± 30.3 cc vs 133.2 ± 64.5 cc, p < 0.0001). Procedure, enucleation, and morcellation times were shorter in the BNI group (all p < 0.0001). There was no statistical difference in same-day discharge rates (90.4% vs 87.7%, p = 0.5), short-term functional outcomes, emergency department (ED) visits, or readmission rates between the two groups. At 14 months mean follow-up, two BNCs occurred in patients in the control group (0.6%), and no BNCs occurred in patients who underwent BNI (0.0%, p = 0.5). Conclusions: BNI at time of HoLEP did not decrease the ability to achieve same-day discharge or increase 90-day complications, ED visits, or readmission rates. No BNCs occurred in patients who underwent prophylactic BNI (0.0%) despite a smaller gland size and lower specimen weight in this cohort. Further prospective studies are required to conclude if concurrent BNI at time of HoLEP is protective against BNC. [ABSTRACT FROM AUTHOR]

Introduction: To improve surgeon-patient communication of postoperative expectations, a multidisciplinary team created and evaluated a holmium laser enucleation of the prostate (HoLEP) expectations handout. Although an effective benign prostatic hyperplasia (BPH) surgery, it is crucial that patients understand the HoLEP recovery. A quality assessment previously performed at our center revealed 11% of patients were not aware of potential ejaculate volume changes. Methods: Patients presenting for consultation prior to HoLEP were assessed with post-procedure patient-reported outcomes (PRO) questionnaires before (n=50) and after (n=50) the implementation of a surgeon-patient expectations handout. Patient demographics and perioperative course were examined in the context of responses. Comparisons were made with a Chi-squared test (p<0.05). Results: We observed a response rate of 96% (pre-handout: 46/50 vs. post-handout: 50/50). Overall, 89/96 (93%) patients felt they had a reasonable understanding of HoLEP expectations, with no difference between cohorts (45/46 vs. 48/50, p=0.71). There was no difference in reporting an understanding of post-HoLEP hematuria (p=0.12) or urinary incontinence (UI) (p=0.99). The implementation of the handout improved understanding of retrograde ejaculation (pre-handout: 41/46 vs. post-handout: 50/50, p=0.022) and dysuria (pre-handout: 35/46 vs. post-handout: 46/50, p=0.048). Fiftyfive patients experienced any dysuria postoperatively, with 89% reporting less than or equal to what they expected. Close to 30% (28/94) of respondents offering ways to improve communication suggested an educational website. Conclusions: The implementation of a surgeon-patient handout during HoLEP consultation improved understanding of postoperative retrograde ejaculation and dysuria at our center. We identified areas for future technology-aided improvements in post-HoLEP communication. [ABSTRACT FROM AUTHOR]

Objective: To investigate perceived barriers to successful same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) from the perspective of surgical and nursing staff members.Methods: A 17-question survey was administered to intraoperative and postoperative surgical staff in June 2021 after a six-month period of implementing a SDD HoLEP pathway with same-day catheter removal. McNemar's and Stuart-Maxwell tests were performed for statistical analysis.Results: Surveys were completed by 30 respondents. The majority of respondents had less than 5 years of surgical experience (63%). Almost all respondents (96%) felt that HoLEP patients could be discharged safely on day of surgery. Overall, 60% felt that HoLEP had a lower risk of post-operative bleeding compared to other transurethral surgeries. There was a significant decrease in number of respondents that felt apprehensive when comparing initiation of SDD HoLEP pathway to 6-months post-implementation (43% vs 7%, P = .003). The most common factors causing apprehension both pre- and post-implementation included: degree of hematuria (43% vs 40%, P = .56), risk of failure of trial of void (40% vs 30%, P = .26), and risk of readmission or unplanned emergency department (ED) visit (33% vs 30%, P = .48). There was a significant decrease in the number of respondents who were apprehensive about lack of experience with SDD after HoLEP comparing pre- and post-implementation (20% vs 0%, P = .01).Conclusion: While staff report initial apprehension regarding implementation of a SDD HoLEP pathway, adequate support to intraoperative and postoperative teams helps build experience that alleviates these concerns. [ABSTRACT FROM AUTHOR]

Objective: To define risk factors and perioperative outcomes for matrix stones and compare these outcomes with struvite and calcium stone cohorts.Methods: A retrospective cohort study comparing matrix stones (n=32), struvite stones (n=23) and a matched, calcium stone control group (n=32) was performed. Two-way ANOVA was used to compare the groups for continuous variables. Chi-square tests were used to compare categorical variables. Significance was set at P <.05. All statistical tests were performed using R (v1.73).Results: We identified no differences in age, gender, or BMI between the three groups. Matrix and struvite stones were more likely to have a history of prior stone surgery and recurrent UTIs compared to calcium stones (P=.027 and P <.001, respectively). Struvite stones were more likely to present as staghorn calculi compared to matrix or calcium stones (56.5% vs 21.7% vs 18.8%, P=.006). There were no significant differences in postoperative stone free rates (P=.378). No significant differences in postoperative infectious complications were identified. Matrix stones were more likely to have Candida on stone culture compared to the struvite or calcium stones (P <.0001).Conclusion: Matrix and struvite stones were more likely have a history of stone surgery and preoperative recurrent UTIs. Struvite stones were more likely to present as staghorn calculi. Matrix stones were more likely to have Candida present in stone cultures. However, no difference in postoperative infectious outcomes or stone free rates were identified. Further study with larger cohorts is necessary to distinguish matrix stone postoperative outcomes from struvite and calcium stones. [ABSTRACT FROM AUTHOR]

Background: Outcomes of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia has been well studied. As comfort with the procedure has improved, the number of concurrent surgeries performed with HoLEP has increased. Technology and technique optimization have safely transitioned HoLEP toward same-day catheter removal and discharge. We aim to assess the success and safety of transitioning toward a same-day care pathway for patients undergoing concurrent surgeries with HoLEP. Materials and Methods: With institutional review board approvals, we queried the electronic medical record and retrospective clinical registry to examine perioperative characteristics and outcomes of patients who underwent HoLEP performed by two endourologists at two centers between July 1, 2016, and June 1, 2021, in which ≥1 concurrent surgical procedure was performed. Results: There were 188 patients with an average age of 72.3 years, who underwent HoLEP with ≥1 concurrent surgical procedure within the study period. In total, 221 non-HoLEP procedures were performed with 30/188 (16.0%) undergoing ≥3 total procedures in a single operation. The four-most common concurrent procedures were cystolitholapaxy 86/221 (38.9%), ureteroscopy 57/221 (25.8%), transurethral resection of bladder tumor 14/221 (6.3%), and percutaneous nephrolithotomy 14/221 (6.3%). Postoperatively, 3 (1.6%) patients required transfusion. After transitioning to a same-day care path, the proportion of patients who had successful same-day catheter removal and same-day discharge increased (all p < 0.05). Median length of stay decreased (from 23 hours 11 minutes to 3 hours 49 minutes, p = 0.008). Our 90-day readmission rate for urology complication was 7.9%, and only 3.6% of patients undergoing concurrent stone surgery required an additional stone surgery within 90 days. The overall Clavien–Dindo ≥3b rate was 4.8% (9-3b, 0-4, 0-5). Conclusions: Advances in HoLEP technique and technology allow for safe same-day discharge for concurrent surgery performed at the time of HoLEP. Few patients were readmitted within 90 days and no patients experienced Clavien–Dindo ≥4 complications. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to compare holmium laser enucleation of the prostate (HoLEP) outcomes in patients with and without neurologic diseases (ND). Methods: A prospectively maintained database of patients undergoing HoLEP from January 2021 to April 2022 was reviewed. The following NDs were included: diabetes-related neuropathy/neurogenic bladder, Parkinson’s disease, dementia, cerebrovascular accident, multiple sclerosis, traumatic brain injury, transient ischemic attack, brain/spinal tumors, myasthenia gravis, spinal cord injury, and other. Statistical analysis was performed using t-tests, Chi-squared, and binomial tests (p<0.05). Results: A total of 118 ND patients were identified with 135 different neurologic diseases. ND patients were more likely to have indwelling catheters (57% vs. 39%, p=0.012) and urinary tract infections (UTIs) preoperatively (32% vs. 19%, p=0.002). Postoperatively, ND patients were more likely to fail initial trial of void (20% vs. 8.1%, p<0.001) and experience an episode of acute urinary retention (16% vs. 8.5%, p=0.024). Within 90 days postoperative, the overall complication rate was higher in the ND group (26% vs. 13%, p=0.001). Within the ND group, 30/118 (25%) had ≥1 UTI within 90 days preoperative, which decreased to 10/118 (8.7%) 90 days postoperative (p<0.001). At last followup (mean 6.7 months [ND] vs. 5.4 months [nonND], p=0.03), four patients (4.4%) in the ND group required persistent catheter/clean intermittent catheterization compared to none in the non-ND group (p=0.002). Conclusions: Patients with ND undergoing HoLEP are more likely to experience postoperative retention and higher complication rates compared to non-ND patients. While UTI rates are higher in this population, HoLEP significantly reduced three-month UTI and catheterization rates. [ABSTRACT FROM AUTHOR]