BERKELEY, CA (UroToday.com) - While the number of office-based urologic procedures continues to increase in order to meet the demands of an aging population, this number is offset by a limited number of new urologists entering the workforce. To meet such demands, a paradigm shift is occurring whereby urologists are turning toward increasing office-based procedures in an effort to efficiently meet patients’ demands. However, does this shift compromise quality of care? Previous reports have demonstrated that urologic procedures performed in an ambulatory surgery center setting do not adversely affect patient outcomes; but what about office-based procedures?
Perhaps one of the most common procedures performed by urologists is a transurethral resection of the prostate (TURP) used for the treatment of benign prostatic hyperplasia (BPH). When examining office-based treatments for BPH, the urologist has several options in his/her armamentarium. Aside from medications, the urologist may turn toward transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), or holmium laser enucleation of the prostate (HoLEP) as office-based procedures designed to decrease bladder outlet obstruction secondary to BPH. While traditionally the GreenLight™, laser has been used in an operating room setting, it has gained widespread acceptance as one modality to perform a TURP, with numerous reports demonstrating safety, efficacy, and durability.
In this study, we present one of the first reports to evaluate the GreenLight™ laser in an office-based setting. We found that in appropriately selected men, with prostate volumes less than 60cc and minimal perioperative risk (median ASA score was ≤ 2), this surgical modality is safe, efficacious, and durable. In our retrospective series of 47 men who all underwent office-based GreenLight™ laser prostatectomies with local peri-prostatic block and mild sedation, there were no intraoperative complications observed. At 90 days, one patient presented to the emergency room with clot retention; meanwhile, 9% of men complained of dysuria. At one-year follow-up, the median AUASS/IPSS, PVR and QoL scores were significantly decreased and median urinary flow had improved when compared to preoperative urometrics. The benefits for office-based procedures are numerous including: improved patient compliance, time, and cost-effectiveness. We suspect that surgical technique may be compromised with larger-sized glands when patients are under local anesthesia. Furthermore, only those with extensive experience with the GreenLight™ laser should transfer this procedure to an office-based setting.
Written by:
E. Charles Osterberg, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Weill Cornell- New York Presbyterian Hospital
Resident Surgeon
Department of Urology
New York, NY 10021 USA
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