Day-case HOLEP: How to optimize outcomes? Insights from 10 years of clinical experience

INTRODUCTION: Most international guidelines recommend HoLEP for the surgical management of BPH. The main advantages reported by randomized studies are reduced perioperative bleeding, catheterization time, and length of hospitalization. To optimize patient care and address healthcare costs, day-case HoLEP has been developed, with our team among the first to implement this approach in 2012. This study aimed to evaluate the evolution of our outcomes over time and to identify predictive factors for day-case failure. MATERIALS AND METHODS: Clinical data on HoLEP procedures were prospectively collected. We retrospectively analyzed perioperative data from consecutive day-case procedures performed at our institution between January 2013 and April 2024 by a single expert surgeon (n=721). Day-case success was defined as discharge within 12hours of admission without readmission within 48hours. The cohort was divided into three chronological groups of 240 patients each to assess the evolution of outcomes over time. Uni- and multivariate analyses were performed to identify predictive factors of failure. RESULTS: Overall, 86.6% of patients (n=625) were discharged within 12hours, and 84.1% (n=606) were not readmitted within 48hours. The main cause of discharge failure was hematuria requiring bladder irrigation. Day-case failure rates remained stable across the three chronological groups. In univariate analysis, prostate volume (P=0.03) and prostate volume >90g (P=0.01) were associated with discharge failure. In multivariate analysis, prostate volume >90g remained the only independent predictor (OR=1.9, P=0.015). CONCLUSION: Day-case HoLEP is a safe and feasible option that does not increase patient risk and should be considered in routine practice. Prostate volume >90g is the only significant predictor of failure, while other patient-related factors have no impact.