Presented by: Maria Epino BS
University of California, Irvine, Department of Urology

Introduction

Robot-assisted simple prostatectomy (RASP) has been shown to have favorable perioperative outcomes for large prostate sizes (>100 mm3). It has lower perioperative morbidity rates and shorter recovery time compared to open surgery and the learning curve is shorter compared to laser enucleation of the prostate. Same-day discharge (SDD) pathway for RASP might reduce the cost of care. 

In this study, we report outcomes of our RASP with the SDD pathway. 

Materials

Following the IRB approval, data from 34 patients who underwent RASP between July 2021 to March 2023 were collected prospectively.  

Patients follow ERAS protocol and are given preoperative and postoperative educational materials. SDD pathway is explained by healthcare providers. Data of unintended calls or text messages to healthcare providers through the Epic MyChart as well as unintended visits to urology clinic or Emergency Department (ED) was collected. 

Results

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Patient characteristics are demonstrated in Table 1. 19 (57.6%) patients were in retention before surgery, 27 (81.8%) patients reported using alpha-blockers while 13 (39.4%) patients were using 5-α reductase inhibitors preoperatively. Mean operative time was 134.97 ± 34.8 mins, median estimated blood loss was 100 (50 – 100) mL, median weight of the resected adenoma was 72.13 (43.73 - 96.38) mL. Median length of hospital stay was 152 (116.5 - 191) mins and median pain score at discharge time was 3 (0 – 4.25). None of the patients required continuous bladder irrigation or had surgical drain. Median length of the catheterization was 7 (7 – 8) days. There were no perioperative complications, blood transfusion, or conversion to open. 31 (91.2%) were discharged home on the day of surgery and all patients were able to urinate after the catheter removal. Two patients were readmitted in 30 days due to the causes unrelated to the same day discharge. Only 4 (12.1%) patients needed to visit the clinic or ED and 3 (9.1%) patients needed to contact healthcare providers during the 1st week after surgery. 

Conclusion

Outpatient RASP is an excellent option to eliminate routine hospital stays with favorable postoperative outcomes. This might encourage surgeons to adapt RASP into their BPH practice, without the pressure for capital investment and steep learning curve required to offer laser enucleation.   

Funding

This study received no fundings.

Co-Authors

Narmina Khanmammadova, MD
University of California, Irvine, Department of Urology

Tuan Thanh Nguyen, MD, MSc
University of Medicine and Pharmacy at Ho Chi Minh City

Rafael Gevorkyan, MS
University of California, Irvine, Department of Urology

Maria Epino, BS
University of California, Irvine, Department of Urology

Jacob Basilius, MD
University of California, Irvine, Department of Urology

Catherine Fung, NP
University of California, Irvine, Department of Urology

Caroline Nguyen, PA
University of California, Irvine, Department of Urology

Sohrab Naushad Ali, MD, MSc, FRCSC
University of California, Irvine, Department of Urology

Mohammed Shahait, MBBS
Clemenceau Medical Center, Department of Surgery

David I Lee, MD, FACS
University of California, Irvine, Department of Urology