508 The Introduction of Daycase HoLEP in a Peripheral Hospital

Abstract Aim To describe the introduction of daycase HoLEP in a geographically remote, peripheral hospital. Establish the safety of this compared to published data. Method Daycase protocol developed for bladder outflow obstruction surgery, including HoLEP. Special considerations were given to the challenges of introducing this in a remote hospital, with no ITU support and which may have a single anaesthetist and surgeon. Retrospective analysis of prospectively collected data from June 2022 to August 2023. Results Patient eligibility for daycase surgery include living within one hour of hospital; ASA 1-2; prostate volume 150cc and able to manage a catheter. Patients are placed on the morning list and leave theatre with a 22Ch 3 way catheter with irrigation running, which is switched off in recovery after 1 hour (if clear). They are reviewed by the surgeon at 4 hours post-op. Daycase discharge is completed if: urine was clear/rose, patient mobilising, eating and drinking, BP within 10% of pre-op level. 17 patients underwent daycase HoLEP (median age 69). 100% of patients were daycase. Mean pre-op prostate size 100cc (n=13), mean enucleated volume 51cc (range 3-95). One patient returned to theatre for haemostasis on the day. No patients required transfer to main hospital. One re-admission within 30 days (5.96%, compared to 5.5%-8% in literature). One patient failed TWOC at day five then passed at two weeks. Conclusions Daycase HoLEP in a remote hospital is safe and effective. This is a credible method of providing the service whilst taking strain of the main distract general hospital.