To validate an outpatient bipolar endoscopic enucleation of the prostate (BipolEP) with ultra-early discharge (≤6 hours) protocol

A single-center retrospective study was conducted structured in two deliberate phases: a pilot proof-of-concept phase (n=27) to establish the safety of discharge within <12 hours, followed by an optimized protocol phase (n=53) targeting discharge within ≤6 hours.  Multivariable linear regression analysis was used to identify predictors of length of stay. The two groups were comparable in terms of age (median 71.0 vs. 69.0 years, p = 0.178) and prostate volume (median 90.0 vs. 80.0 g, p = 0.94), confirming cohort homogeneity and the validity of the comparison. All procedures were performed under general anesthesia with either orotracheal intubation or laryngeal mask airway, using a 26Fr Karl Storz continuous-flow resectoscope, a BOWA ARC 400 bipolar generator (settings: vaporization mode, energy level 2 for cutting and 3 for coagulation), and a Karl Storz vapoenucleation electrode.

Across the entire cohort (n = 80), there were no cases of hospital readmission or reintervention throughout the protocol follow-up period. No patient required return to the operating room for bleeding or clot retention. Minor complications (Clavien–Dindo grade I–II) occurred in 5 patients (6.3%): 3 cases of transient hematuria managed conservatively and 2 cases of urinary tract infection treated with oral antibiotics. No major complications (Clavien–Dindo grade III–V) were observed.
In the optimized protocol phase, 100% of patients (53/53) achieved the ≤6-hour discharge target (median 3 hours, IQR 3–4), with zero 30-day readmissions. Multivariable analysis on optimized protocol phase (≤6-hour discharge) identified hemostatic efficiency (hemostasis time in minutes per gram of enucleated tissue; Beta = 0.848, p < 0.001) as the strongest independent predictor of shorter length of stay, whereas preoperative prostate volume was not a significant predictor.

The two-phase study design serves as a model for the safe implemantation of an outpatient bipolar endoscopic enucleation of the prostate (BipolEP) with ultra-early discharge (≤6 hours) protocol.  Phase 1 provided evidence supporting the feasibility of earlier discontinuation of continuous bladder irrigation and demonstrated that discharge within 12 hours was achievable, thereby giving the team the confidence to implement changes that enabled ultra-early discharge in Phase 2 (≤6-hour discharge). This structured approach mitigates the risks associated with abrupt changes in clinical practice and provides a robust framework for validating new protocols prior to widespread adoption.

Ultra-early discharge (≤6 hours) after bipolar endoscopic enucleation of the prostate (BipolEP) is safe and highly effective when implemented within a structured and optimized protocol.

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Agarwal DK, Large T, Tong Y, et al. Same Day Discharge is a Successful Approach for the Majority of Patients Undergoing Holmium Laser Enucleation of the Prostate. Eur Urol Focus. 2022;8(1):228-234. doi:10.1016/j.euf.2021.01.003