Category: Education, Simulation & Virtual Reality

MP22-21 - Application of a Hematuria Grading Scale and its Impact on the Postoperative Care and Management of Patients undergoing Holmium Laser Enucleation of the Prostate

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Post-operative gross hematuria is often difficult to characterize. In efforts to improve communication and patient care, we implemented a simple hematuria grading scale (HGS) to describe the quality of a patient’s urine following Holmium Laser Enucleation of the Prostate (HoLEP) to determine if further intervention is needed. We explore the associations between a patient’s urine grade and returns to the operating room, emergency department (ED), or need for additional intervention.


Methods :

Retrospective review of prospectively collected data was conducted on patients undergoing HoLEP between 2/2017 – 8/2017. All procedures were performed by a single, experienced surgeon [MET] using 550 μm holmium laser. All patients underwent enucleation, morcellation, and hemostasis in a standardized fashion. Hematuria urine grades were determined on postoperative day 1 (POD1) using an institutionally-developed and validated HGS scored from 0-4 by a resident care team.


Characteristics and POD1 hematuria urine grades were analyzed. Primary endpoint was return to the operating room for bleeding. Secondary endpoints were need for additional interventions or return to the ED.


Results :

53 total patients were identified with their characteristics, POD1 urine grades, outlined in Table 1. Postoperatively, 1 (1.9%) required OR clot evacuation, 3 patients (5.6%) required re-catheterization for inability to void, and 8 (15.1%) returned to the emergency room due to LUTS.


Bivariate analysis was performed with no significant differences detected between POD1 urine grades and age, BMI, post-op hemoglobin, POD1 re-catheterization, OR takebacks or return to the ED. A significant association was detected between POD1 grade 3 urine and the need for bedside hand irrigation. (p=0.0301)


Conclusions :

There is a paucity of studies that utilize a HGS and apply it to the postoperative care and management of patients undergoing HoLEP. We demonstrate with a small sample size that there is a significant association between POD1 urine grade and need for manual hand irrigation in patients with grade 3 urine.  HGS may be a valuable prognostication tool in predicting a patient’s post-operative course and management.

Marawan M. El Tayeb

Assistant Professor
Baylor Scott and White Health
Temple, Texas

Lawrence Tsai

Temple, Texas

Colin Kleinguetl

Temple, Texas

Andrew F. Navetta

Resident Physician
Baylor Scott and White Health
Temple, Texas

G Luke Machen

Temple, Texas

Trey D. Durdin

Resident Physician
Baylor Scott and White Health
Temple, Texas

Erin Bird

Baylor Scott and White
Temple, Texas