Is hospitalization still necessary? A systematic review of outpatient HoLEP over the last decade.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is a well-established, size-independent surgical intervention for benign prostatic hyperplasia (BPH). Traditionally performed with overnight hospitalization, there is increasing interest in same-day discharge to reduce healthcare costs and improve patient satisfaction. This systematic review evaluates the feasibility, safety, efficacy, and cost-effectiveness of HoLEP as an outpatient procedure across all patient populations between 2015 and 2025. Material and methods: A systematic search of PubMed and Google Scholar was conducted in accordance with PRISMA guidelines, yielding 15 eligible studies including over 1,500 patients. Outcomes analyzed included same-day discharge rates, readmissions, complications, symptom improvement, and patient satisfaction. Subgroup analyses examined outcomes by age, comorbidities, prostate size, and anticoagulation status. Results: Same-day discharge (SDD) rates ranged from 60-90%, with contemporary studies achieving rates above 85% in unselected populations. Readmission rates were low (~2-5%), with no significant increase compared to inpatient care. Complication profiles were similar between outpatient and inpatient settings, with most being minor. Functional outcomes such as International Prostate Symptom Score and urinary flow rates showed marked improvement postoperatively, comparable to traditional HoLEP. Advanced laser technology, early surgery scheduling, and standardized post-anesthesia protocols were key facilitators. Cost analyses demonstrated per-case savings of $750-$840 with outpatient care. Older age and anticoagulation were not absolute contraindications for SDD when proper criteria were met. Conclusions: HoLEP can be safely and effectively performed as an outpatient procedure in most patients, offering comparable outcomes to inpatient care while reducing costs and enhancing patient satisfaction.