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Objectives: To describe the contemporary evolution of day‐case bladder outflow obstruction (BOO) surgery in England and to profile day‐case BOO surgery practices across England in terms of the types of operation performed and their safety profiles. Materials and Methods: This was a retrospective observational analysis of Hospital Episode Statistics and UK Office for National Statistics data. All 111 043 recorded operations across 117 hospital trusts over 66 months, from 1 January 2017 to 30 June 2022, were obtained. Operations were identified as one of: transurethral resection of prostate (TURP); laser ablation or enucleation; vapour therapy; prostatic urethral lift (PUL); or bladder neck incision. Monthly day‐case rate trends were plotted across the study period. Descriptive data, day‐case rates and 30‐day hospital readmissions were analysed for each operation type. Multilevel regression modelling with mixed effects was performed to determine whether day‐case surgery was associated with higher 30‐day hospital readmissions. Results: Day‐case patients were younger, with fewer comorbidities. Time series analysis showed a linear day‐case rate increase from 8.3% (January 2017) to 21.0% (June 2022). Day‐case rates improved for 92/117 trusts in 2021/2022 compared with 2017. Three of the six trusts with the highest day‐case rates performed predominantly day‐case TURP, and the other three laser surgery. Nationally, PUL and vapour surgery had the highest day‐case rates (80.9% and 38.1%). Most inpatient operations were TURP. Multilevel regression modelling found reduced odds of 30‐day readmission after day‐case BOO surgery (all operations pooled), no difference for day‐case vs inpatient TURP, and reduced odds following day‐case LASER operations. Conclusions: The day‐case rates for BOO surgery have linearly increased. Minimally invasive surgical technologies are commonly performed as day cases, whereas high day‐case rates for TURP and for laser ablation operations are seen in a minority of hospitals. Day‐case pathways to treat BOO can be safely developed irrespective of operative modality. [ABSTRACT FROM AUTHOR]

Background: To determine real-world outcomes of prostatic urethral lift (UroLift) procedures conducted in hospitals across England.Methods: A retrospective observational cohort was identified from Hospital Episode Statistics data including men undergoing UroLift in hospitals in England between 2017 and 2020. Procedure uptake, patient demographics, inpatient complications, 30-day accident and emergency re-attendance rate, requirement for further treatment and catheterization were captured. Kaplan-Meier and hazard analysis were used to analyse time to re-treatment.Results: 2942 index UroLift procedures from 80 hospital trusts were analysed; 85.3% conducted as day-case surgery (admitted to hospital for a planned surgical procedure and returning home on the same day). In-hospital complication rate was 3.4%. 93% of men were catheter-free at 30 days. The acute accident and emergency attendance rate within 30 days was 12.0%. Results of Kaplan Meier analysis for subsequent re-treatment (including additional UroLift and endoscopic intervention) at 1 and 2 years were 5.2% [95% CI 4.2 to 6.1] and 11.9% [10.1 to 13.6] respectively.Conclusions: This real-world analysis of UroLift shows that it can be delivered safely in a day-case setting with minimal morbidity. However, hospital resource usage for catheterization and emergency hospital attendance in the first 30 days was substantial, and 12% required re-treatment at 2 years. [ABSTRACT FROM AUTHOR]

Aims: To capture in-depth qualitative evidence regarding attitudes to and experiences of urodynamic testing among men with lower urinary tract symptoms (LUTS) at each end of the clinical pathway., Methods: Semi-structured interview study conducted within the Urodynamics for Prostate Surgery: Randomized Evaluation of Assessment Methods (UPSTREAM) trial, which randomized men to a care pathway including urodynamics or routine non-invasive tests from 26 secondary care urology sites across England. Men were interviewed after assessments but prior to treatment, or after surgery for LUTS. Men were purposively sampled to include those who had urodynamics and those who did not, and diversity in demographic characteristics and symptom burden. Interviews were analyzed using inductive thematic analysis., Results: Forty-one men participated (25 pre-treatment, 16 post-surgery), ages 52-89. The 16 men who had not previously experienced urodynamics said they would accept the test in their assessment, but some were apprehensive or wanted more information. The 25 men who had experienced urodynamics all found it acceptable, though some reported pain, infection, or embarrassment. Embarrassment was minimized by informing patients what the procedure would be like, and ensuring privacy. Urodynamics was valued for its perceived diagnostic insight. Information deficits were reported before, during, and after the test. How and when results were explained and the adequacy of explanations varied., Conclusions: Urodynamics is acceptable to men with LUTS and generally well-tolerated. To ensure patients are prepared and informed, good communication before and during the procedure is essential. Privacy should be prioritized, and test results discussed promptly and in sufficient detail. Staff require training and guidance in these areas., (© 2017 The Authors. Neurourology and Urodynamics Published by Wiley Periodicals, Inc.)