Holmium laser enucleation of prostate in nonagenarians and octogenarians

Impact of age and frailty on surgical outcomes

Authors

  • Mohamed Elsaqa Faculty of medicine, Alexandria University
  • Yu Zhang Baylor Scott & White Health, Temple, Texas
  • Marawan M. El Tayeb Baylor Scott & White Health, Temple, Texas

DOI:

https://doi.org/10.5489/cuaj.8211

Keywords:

Prostate enucleation, Laser surgery, Geriatric, Frailty, Complications, HoLEP

Abstract

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) is a well-established technique for management of benign prostatic hyperplasia (BPH). With the growing aging population, a considerable percentage of octogenarians (80–90 years old) and nonagenarians (>90 years old) require surgical management for BPH. We aimed to assess the outcomes of HoLEP in those age groups.

METHODS: We reviewed a maintained database for HoLEP patients in a tertiary center. Patients were assigned to two groups: above (group A) and below (group B) 80 years old. Perioperative outcome and postoperative followup data were compared between both groups.

RESULTS: The study included 1090 patients, 201 and 889 in groups A and B, respectively. Median age was 83 and 70 years in groups A and B, respectively. Group A showed longer operative time, longer catheterization time, and higher 30-day emergency room visits and readmission rates. Hemoglobin drop was comparable, although associated with higher rate of blood transfusion in group A. Overall, 30-day postoperative complications were higher in group A (20.8% vs. 9.3%, p=0.008), although the majority of complications in both groups were grade I and II. The rate of complications over Clavien-Dindo grade II were statistically comparable (3.4% vs. 1.79%, p=0.133). Followup at six weeks, three months, and one year showed comparable functional outcomes in both groups.

CONCLUSIONS: HoLEP is a safe and effective option in the geriatric population of octogenarians and even nonagenarians. HoLEP is associated with higher overall complication rate in older age groups; however, most complications were minor.

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Published

2023-07-11

How to Cite

Elsaqa, M., Zhang, Y., & El Tayeb, M. . (2023). Holmium laser enucleation of prostate in nonagenarians and octogenarians: Impact of age and frailty on surgical outcomes. Canadian Urological Association Journal, 17(9), E263–8. https://doi.org/10.5489/cuaj.8211

Issue

Vol. 17 No. 9 (2023): CUAJ September

Section

Original Research

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