Presentation Authors: Serena Maruccia*, Ella Kinzikeeva, Paolo Spiga, Gianluca Cacace, Stefano Casellato, Monza, Italy
Introduction: Since January 2017, with the reappointment of its urology staff, a new thulium laser has been introduced in the treatment of benign prostatic hyperplasia at the Zucchi Clinical Institutes of Monza.Before the introduction of the thulium, surgery involved bTURP and prostatectomy carried out by two expert surgeons, each having performed more than 500 procedures. The new staff had equal expertise in the laser technique.Hence, the economic and managerial impact of the introduction of the thulium laser surgery was examined in the treatment of benign prostatic hyperplasia.
Methods: Together with our Health Directorate, we analysed all the bTURP and prostatectomy carried out in 2016, and we matched them with the ThuVEP carried out in 2017. We examined such factors as time spent in the operating room, length of hospital stay and cost of the procedure. We then examined the total number of procedures carried out from 2016 to the first three months of 2018.
Results: The evidence shows that the number of procedures for prostatic hyperplasia has increased considerably (+20%). The average duration of hospital stay has gone up from 7.2 (prostatectomy) and from 4.22 (bTURP) to 2 days with an average economy of 53% with TURP and of 72% with prostatectomy. The average cost of hospital stay is â‚¬674 per day (a). Surgical times decreased by 52% with prostatectomy and by 35% with TURP.A ThuVEP cost/procedure is 25% higher than prostatectomy and 22% higher than bTURP. The elimination of transfusions alone has resulted in an economy of â‚¬2,353.80. The number of Thulep has increased by 79% from first three months of 2017 to the first three months of 2018.
Conclusions: Against a minimal increase in the cost/procedure, the introduction of laser surgery has considerably reduced costs in terms of occupation of the surgical room, hospital beds and elimination of requests of transfusions. The introduction of laser technology also entails an increase in the number of patients per specific pathology. The reduction of hospital stay and the increase in case studies suggest an overall optimization as well as rationalisation of human and structural resources.