Same-day Discharge Following Holmium Laser Enucleation of the Prostate Under Spinal Anesthesia: A Propensity Score Matched Comparison With General Anesthesia

Abstract

Objective

To determine if using spinal anesthesia (SA) for holmium laser enucleation of the prostate (HoLEP) impacted the ability to perform same-day discharge (SDD) compared to a prostate volume-matched cohort undergoing HoLEP under general anesthesia (GA).

Methods

From January 1, 2021 to March 28, 2024, 995 men underwent HoLEP by a single surgeon. Three hundred eleven were identified who had SA and a recorded preoperative prostate volume. Propensity score matching based on prostate volume was performed with the remaining cohort who received GA in a 1:1 ratio. The primary outcome was rate of SDD.

Results

When comparing SDD between the two groups, 84% of SA patients had SDD compared to 74% of GA patients (P-value .002). The operative time for SA was significantly shorter than GA (89 vs 101 minutes P-value <.001). The total operating room time (wheels-in to wheels-out) including anesthesia induction for SA was significantly shorter than GA (119 vs 128 minutes P-value .0003). There were no significant differences in early catheter reinsertion, emergency department visits, complications, or postoperative serum prostate-specific antigen measured at 3 months.

Conclusion

Utilizing SA for HoLEP did not preclude SDD compared to a prostate volume-matched cohort who underwent HoLEP under GA. In fact, SDD were higher in the SA cohort without a corresponding increase in emergency department visits or catheter reinsertion.