Day-case transurethral resection of the prostate (TURP) is possible for three-quarters of men

Introduction & Objectives: TURP remains one of the most common Urological operations and although proponents of novel BPH procedures highlight same day discharge as an advantage it has been our practice (since acquiring the ability to perform Transurethral Resection in saline (TURis) in 2011) to routinely perform TURP as a day-case entity. In this study, we review our performance and describe how we have adapted care pathways to safely increase our same-day discharge rates. Materials & Methods: A total of 1038 procedures coded as TURP performed in a single centre over a 66-month period (2011-2016) were retrospectively analysed. Clinical notes and computer records were reviewed to determine: Day-case/ inpatient (and conversion from one to the other) rates, re-admission occurances, transfusion rates, weight of resected tissue and operating times. We also considered the reasons for readmission. Where performed, analysis for statistical significance was assessed with the Pearson's chi-squared test. Results: Of the 1038 procedures, 692 (66%) were planned as day-cases (DC), and 346 (34%) were planned for admission (IP). Of the DCs 177 (26%) required admission, and of the planned IPs 58 (17%) were sent home on the day of surgery. Thus, in total there were 573 (55.2%) day case procedures (mean age 70.7 years, mean operating time 36.8 minutes and mean resected tissue weight 10.1 grams) and 465 (44.8%) inpatient procedures (mean age 73.7 years, mean operating time 47.5 minutes and mean resected tissue weight 15.7 grams). Since 2011 there has been a steady increase in the proportion of procedures performed as day-case (48.7% in 2011;75.9% in 2016), with a decrease in the proportion being converted to inpatient stays. 42 (7.3%) patients who had a DC TURP and 29 (6.2%) who had IP TURP were readmitted within the next 30 days (p=0.48 NSS). The most common reasons for readmission were urosepsis and haematuria. Four day-case patients (1%) compared to 17 IP men (4%) required a blood transfusion post-operatively (p<0.05). Conclusions: With specific adaptations, routine day surgery TURP is feasible for the majority of men. We propose adaptations to aid day-case TURP: 1. Careful patient selection, men with complex anticoagulation management, significant comorbidities, or those with no one at home to care for them should not be offered TURP as day case 2. Manage patient expectations so that they are expecting to go home shortlt after the operation 3. Meticulous haemostasis 4. Recovery nurses in trained in irrigation management 5. “Soft” 3-way catheters 6. Readily available TWOC (trial without the catheter) clinic slots (we routinely remove catheter after 48 hours in the outpatient department) 7. “Open access” to a nurse led outpatient service to deal with problems 8. Availability of “consultant of the week” to readily advise where necessary. With the above adaptations, TURP we believe, can be offered routinely as a day-case procedure.