Education, Simulation & Virtual Reality

Moderated Poster Session

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

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 252B

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

Marawan El Tayeb, MD, MSc, Ph.D. is an Assistant Professor, Division of Urology in Texas A&M College of Medicine and the Director of international education and Research, Department of Surgery in Baylor Scott and White Medical Center, Temple, TX.
Dr. El Tayeb completed his urology residency at Alexandria University Hospitals, Egypt. In 2013, Dr. El Tayeb finished a pediatric urology fellowship at Cincinnati Children’s Hospital Medical Center; he then moved to Indianapolis and started Endo-Urology fellowship in Indiana University with Dr. James Lingeman. He then moved to Texas in July 2015, and since then he has been working at Baylor Scott and White Health Medical Center in Temple, TX.

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      Colin Kleinguetl

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        Andrew F. Navetta

        Resident Physician
        Baylor Scott and White Health

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          G Luke Machen

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            Trey D. Durdin

            Resident Physician
            Baylor Scott and White Health

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              Erin Bird

              Baylor Scott and White

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