Age‐stratified outcomes of holmium laser enucleation of the prostate

Abstract

Objective• To present the first age-stratified assessment of outcomes after holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms resulting from prostate enlargement. Patients and Methods• We retrospectively analysed and compared the morbidity, and the peri-operative and functional outcomes of patients aged 50-59, 60-69, 70-79 and Ն80 years. Complications at 30 days were stratified using the Clavien system. • Functional outcomes were assessed using the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR) and urinary continence. Results• A total of 311 patients underwent HoLEP for obstructive voiding symptoms from August 2007 to June 2011, of whom 22 patients were aged 50-59 years, 91 were aged 60-69 years, 153 were aged 70-79 years, and 45 were aged Ն80 years.• The overall morbidity rates were similar among the age groups (20, 24.4, 21.6 and 22.1% for groups 1, 2, 3 and 4, respectively), as were the incidence of significant complications (Clavien grade Ն III), change in serum haemoglobin level, and length of hospital stay.• Patients Ն80 years did have a longer catheterization time (3.4 days) than patients aged 50-59 years (1.68 days).• By 1 year there were no significant differences in urinary continence, IPSS, Qmax, or PVR among the age groups. Conclusions• Overall morbidity, hospital stay, and 1-year functional outcomes of HoLEP were similar among all age groups. • This study shows that HoLEP is a safe and effective treatment for benign prostatic hyperplasia regardless of age.

Assessing the Outcome of Holmium Laser Enucleation of the Prostate by Age, Prostate Volume, and a History of Blood Thinning Agents: Report from a Single-Center Series of >1800 Consecutive Cases

“…Of note, the association of patient age and HoLEP efficacy/safety has been scarcely explored to date. 11,18,19 Existing studies-although cohort sizes and differences in reporting somewhat hinder comparisonconclude on HoLEP as equally effective, irrespective of age. Importantly, differences are observed with respect to complications.…”

Holmium Laser Enucleation of the Prostate is Safe for Patients Above 80 Years: A Prospective Study

“…Oral anticoagulant use independently affects TURP outcome, with longer hospital stay, and higher rates of bleeding, blood transfusion, late hematuria, and thromboembolic events [ 11 ]. As Mmeje et al [ 10 ] reported, the overall blood transfusion rate was highest in patients ≥80 years (11%) who underwent HoLEP. In this study, no patient needed a blood transfusion during surgery.…”

“…Matani et al [ 9 ] reported that early and late complications occurred in 25.9% and 13.2% of patients who underwent TURP, respectively. However, a cohort study of 311 patients who underwent HoLEP procedures reported that the overall morbidity, hospital stay, and 1-year functional outcomes were similar among the 50–59, 60–69, 70–79, and ≥80-year groups [ 10 ]. In our study, hospital stay was significant longer in patients ≥80 years.…”

Anatomical endoscopic enucleation of the prostate: The next gold standard? Yes!

“…In a retrospective study, Mmeje et al stratified HoLEP patients into four groups based on age at surgery (A = 50–59, B = 60–69, C = 70–79, D = 80+ years) (Mmeje, Nunez‐Nateras, Warner, & Humphreys, 2013). There were no significant differences across the 4 groups in terms of: reduction in serum haemoglobin (1.22, 1.42, 1.57, 1.78 g/dl), mean hospital stay (1.18, 1.28, 1.26, 1.68 days), overall complication rates (20%, 24.4%, 21.6%, 22.1%) and Clavian–Dindo Grade 3 + complications (0%, 5.6%, 3.9%, 4.4%).…”