Assessment of the Patient's Perceived Fear and Anxiety During Ambulatory Holmium Laser Enucleation of Prostate: A Prospective, Real-Practice Study from a Single Center

Abstract

Background and Objective: Ambulatory holmium laser enucleation of prostate (HoLEP) has shown low rates of readmission and postoperative complications. However, the patient's experience has been undervalued. We aimed to measure the patient's perceived fear and anxiety during ambulatory HoLEP. Methods: We performed a prospective study on patients scheduled for HoLEP at our institution. We excluded patients with cognitive or psychiatric disorders and those who had to be hospitalized. The week preceding the surgery, we administered the Surgical Fear Questionnaire (SFQ) and the Hospital Anxiety and Depression Scale (HADS) by phone. The day following the surgery, we readministered the HADS and asked the patients if they would undergo HoLEP in the same setting. Key Findings and Limitations: Overall, 70 patients completed the study (mean age 72.3, standard deviation [SD] 6.5 years). The mean SFQ score was 18.4/90 (SD 13.5); the two highest rated items were "I am afraid of pain after the operation" and "I am afraid of unpleasant side effects after the operation." with a mean of 3.7/10 and 2.7/10, respectively. For the HADS, the mean preoperative score was 4.6/21 (SD 3.4), and the mean postoperative score was 3.9/21 (SD 3.0), with a mean difference of -0.7 (p = 0.059). The majority (90%) of patients reported they would undergo HoLEP in the same setting. Conclusions and Clinical Implications: Most patients described low levels of anxiety and fear, and would undergo ambulatory HoLEP again. Given the high satisfaction and low levels of anxiety, widespread adoption of ambulatory HoLEP should be considered. Patient Summary: Men with benign prostatic hyperplasia, or an enlarged prostate, often need surgery to improve urinary function. We studied the acceptability of same-day discharge surgery for this condition by assessing patients' anxiety, fear, and willingness to repeat the procedure. Most patients described low levels of anxiety and fear, and would undergo ambulatory HoLEP again.

Keywords: ambulatory HoLEP; ambulatory prostate surgery; holmium laser enucleation of prostate; patient experience; perceived fear and anxiety.