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

Abstract

Purpose:To evaluate the effect of age on the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for the treatment of symptomatic benign prostatic hyperplasia (BPH).Methods:A total of 579 patients underwent HoLEP procedure performed by a single surgeon (SJO) between December 2009 and May 2013. The perioperative and functional outcomes of patients in the age groups of 50–59 (group A, n=44), 60–69 (group B, n=253), 70–79 (group C, n=244), and ≥80 years (group D, n=38) were compared. The Clavien-Dindo system was used to evaluate clinical outcomes. The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual (PVR) urine volume, and urinary continence were used to assess functional outcomes.Results:In this study, the patients ≥80 years had significantly higher presence of hypertension (P=0.007), total prostate volumes (P=0.024), transitional zone volume (P=0.002), American Society of Anesthesiologists scores (P=0.006), urinary retention (P=0.032), and anticoagulation use (P=0.008) at preoperative period. Moreover, the mean values of operation time, enucleation time, morcellation time, and enucleation weight were higher in group D compared with other group patients (P=0.002, P=0.010, P<0.01, and P=0.009, respectively). Patients aged ≥80 years had a longer hospital stay time (2.9±1.8 days) than other groups (group A, 2.3±0.7 days; group B, 2.3±0.7 days vs. group C, 2.4±0.7 days; P=0.001). All groups were similar in regard to the incidence of complications (Clavien-Dindo grade) post operatively (P>0.05). All the patients in the present study showed improvement in functional outcomes after HoLEP. By the sixth month, there were no significant differences in IPSS, quality of life, Qmax, and PVR among the groups (P>0.05). Conclusions:Compared with younger patients, the patients aged ≥80 years had a similar overall morbidity and 6-month functional outcomes of HoLEP. HoLEP is a safe and effective treatment for BPH among the elderly.

Enucleated Weight/Enucleation Time, Is It Appropriate for Estimating Enucleation Skills for Holmium Laser Enucleation of the Prostate? A Consideration of Energy Consumption

“…Holmium laser enucleation of the prostate (HoLEP) makes it possible to remove an entire enlarged adenoma confidently in the natural-tissue plane of the surgical capsule. A recent study reported that HoLEP is a safe and effective treatment for benign prostatic hyperplasia (BPH) among the elderly [ 1 ]. Compared with younger patients, patients aged ≥80 years had similar overall morbidity and 6-month functional outcomes after HoLEP [ 1 ].…”

“…A recent study reported that HoLEP is a safe and effective treatment for benign prostatic hyperplasia (BPH) among the elderly [ 1 ]. Compared with younger patients, patients aged ≥80 years had similar overall morbidity and 6-month functional outcomes after HoLEP [ 1 ]. Thus, HoLEP is considered a safe and effective treatment modality for bladder outlet obstruction (BOO) related to BPH, and has been reported to have lower morbidity rates than other modalities [ 2 ].…”

Measuring change in prostate size after holmium laser enucleation: A prospective study

“…All operations were performed using a holmium: yttrium-aluminum-garnet laser by two surgeons (SJO and JKO). The holmium laser apparatus used in our study were OmniPulse (Trimedyne Inc., Irvine, CA, USA) and VersaPulse PowerSuite (Lumenis, Yokneam, Israel) [ 8 ].…”

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

“…A prospective study by Piao et al stratified patients into 4 age groups identical to those used by Mmeje et al (Piao, Choo, Kim, Jeon, & Oh, 2016). Despite patients 80 years and older having significantly higher American Society of Anaesthesiologists scores and rates of anticoagulation use, longer operating times and greater enucleation weights, the incidence of complications was similar across the groups.…”