In 2018, Getting It Right First Time (GIRFT) published its national report for Urology surgery, supporting the recommended 80% day-case rate made by British Association of Day Surgery for HoLEP. We describe our discharge protocol for day-case HoLEP. Our objective was to determine its feasibility and safety.

All patients listed for HoLEP between September 2023-June 2024 were considered for same-day discharge (SDD). We developed specific post-operative instructions and discharge protocols. Patients all had meticulous laser haemostasis, 22Fr 3-way catheter inserted, 50ml in catheter balloon and light traction towards end of procedure. All had irrigation titrated to urine colour for an hour post-operatively, stopped once urine clear. If urine remained clear for 30 minutes, the catheter balloon was deflated by 20ml, observed for another 30 minutes and patients discharged with spiggoted 3-way catheter. Most patients were reviewed by surgeon before discharge, with nurse-led discharge guided by urine-colour charts provided [Figure1].

78 cases of HoLEP (median age/ASA:73/2) with mean(range) prostate volume of 107(50-220)mL were performed using the Lumenis Pulse™ 120H Holmium Laser System. 74.4% (58/78) had planned SDD. Planned SDD was not possible due to lack of social cover (8/20), surgical reasons (6/20) and anaesthetic concerns (6/20). 82.8% (48/58) of planned SDD was discharged same-day, with no re-admissions with haematuria within 30-day follow-up period. Haematuria (5/10) was the main reason for unplanned admission post-op.

Day-case HoLEP is feasible and safe. It can be implemented on most patients. Pre-op counselling on day-case nature of procedure and performing case early during the day will improve our day-case rate.