Transurethral resection of the prostate using monopolar current (mTURP) is the most common operation and gold standard treatment for benign prostatic hyperplasia (BPH). [1] Despite a high efficacy, mTURP have an associated overall morbidity close to 20% [1] with most common risks being acute transitory urinary retention, clot retention, post-operative hematuria, urinary tract infection, and TUR syndrome. [1] Newer technologies have been advocated to reduce complications and length of hospital stay. Traditionally, mTURP is performed with a post-operative hospitalisation (POH). At our center, many patients have undergone mTURP as a day care surgery (DCS). To our knowledge, only 2 contemporary studies have reported on the feasibility and safety of this method. [2, 3] We herein review our experience to assess the efficacy and innocuity of mTURP comparing the 30-day complication rates among DCS, POH and the literature.

In this single institutional retrospective study, we reviewed medical records of 628 patients who underwent mTURP between January 1st 2016 to March 31st 2018 after failed medical therapy for BPH. 362 patients underwent mTURP according to our criteria and were included in the final analysis. Patients’ demographics, complications and emergency room (ER) consultations were recorded. Ethics approval was obtained from the local Research Ethics Board.

Of the 362 mTURP procedures, there were 187 day-care surgery (52%) and 175 post-operative hospitalisation. Median age was 71.6 years old (SD: 9.48), 64.5% had an ASA score of 2 and 21.6% of 3 or more. There were no significant differences between the two groups for ASA score, BMI, surgery performed under aspirin (13% in each group) and mean volume of prostate resected (17.4 vs 18.9 gm.). In this retrospective analysed, a slight difference in distribution was seen on anticoagulation, vascular disease, cognitive impairment, diabetes and pre-op bacteriuria. Age distribution is slightly younger in DCS (mean age 70.12, SD 9.56) than in POH (mean age 73.23, SD 9.16). Mean resection time was 48 min in DCS group and 52 min in POH group (p=0.06). Bladder catheter of patient in DCS subgroup was removed mostly within 24 to 48 hours at home by ambulatory nurse’s service, while POH patient’s catheter could be either removed during the hospitalisation or similarly at home.

In each group, 22% of patients consulted in the ER within the first 30 post-operative days, with non-statistically significant rates of hematuria (DCS 11.2% vs POH 11.4%), acute retention (DCS 7.5% vs POH 12%) or UTI (DCS 8.6% vs POH 10.3%). Readmission rate was 4.4% overall (DCS 4.3% and POH 4.6%). Blood transfusion was required for 6 patients in DCS group and 1 in POH group (p=0.06). Reoperation (clot evacuation and fulguration of the prostatic fossa) within 30 days PO occurred in 8 cases in POH group only, none in the DCS group. No death occurred.

Our 30-day complication rates being statistically comparable between the DCS and POH cohorts we consider that this surgery may be safely performed as an outpatient procedure (DCS) for selected patients according to comorbidities lack of intra-operative complication and adequate social support at home. Many patients can be safely discharged on the same day, with the removal of the bladder catheter performed by an ambulatory nursing care service, without increase in complications. If this practice were to become widely spread, it would challenge some studies regarding cost-effectiveness of newer technologies by acknowledging the reduce cost of no hospitalisation with mTURP.

Transurethral resection of the prostate (TURP) using monopolar current can be safely performed as an outpatient day-care procedure for selected patients.  In a cohort of patients, ranging from mild to severe comorbidities, and with a majority treated for chronic retention, no difference in the complication rate was found at 30 days between outpatient (DCS) and inpatient procedure (POH). We acknowledge this is a retrospective study with its inherent bias. 

While initially performed to reduce the admission rate imposed by beds limitation, this method appears feasible and safe for carefully selected patients. Access to ambulatory nurse’s services from hospital discharged (bladder catheter irrigation, removal, advices, etc.) is of crucial importance.

Wein, A.J., et al., Campbell-Walsh urology. 11e ed. 2016, Philadelphia, Pennsylvania: Elsevier.
Khan, A., Day care monopolar transurethral resection of prostate: Is it feasible? Urology Annals, 2014. 6(4).
Bright, E., et al., Day-case monopolar and bipolar transurethral resection of the prostate. Journal of Clinical Urology, 2014. 8(1): p. 63-67.