Prostate laser vaporization is safe and effective in elderly men

Abstract

Introduction:There are few data on the safety and efficacy of laser photoselective vaporization (LVP) in elderly men. We compared the safety and efficacy of LVP for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men ≥75 years, who we defined as elderly, to those <75 years.Materials and Methods:Safety and efficacy outcomes in elderly men undergoing LVP for lower urinary tract symptoms secondary to BPH from 2005 to 2012 were compared with men <75 years. Differences between-groups in demographics, perioperative outcomes, complications, and postoperative changes in International Prostate Symptom Score (I-PSS) were calculated.Results:Of 202 patients, 49 (24%) were elderly (range: 75-95 years) and 153 (76%) were <75 years. Preoperatively, elderly men were more likely to have heart disease (35% vs. 20%, P = 0.03), gross hematuria (6.1% vs. 0.7%, P = 0.05), urinary retention (57% vs. 41%, P = 0.07), and take anti-coagulants (61% vs. 35%, P = 0.002). Elderly men had a longer median length of stay (1 day vs. 0 day, P = 0.001). There were no significant between-group differences in transfusion frequency (4.4% vs. 0.7%, P = 0.14) or Clavien III complications (2% vs. 2.6%, P = 1.0). One month postsurgery, elderly patients reported smaller median decreases in I-PSS (5.5 vs. 9, P = 0.02) and urinary bother (1 point vs. 2, P = 0.03) compared with preoperative values. At till 9 months follow-up, there were no significant between-group differences in median I-PSS or urinary bother scores.Conclusions:Despite a higher prevalence of preoperative comorbidity and urinary retention, elderly LVP patients experienced perioperative safety and shorter term efficacy outcomes comparable to younger men.

Safety and Efficacy of Laser Enucleation of the Prostate in Elderly Patients – A Narrative Review

“…Majumdar et al investigated prospectively the efficacy and safety of laser photoselective vaporization (LVP) in groups aged ≥75 (n=49) and <75 years (n=153). 24 In contrast to Castellani et al, the ≥75 age group’s median LOS was significantly longer (1 day vs 0 days; P = 0.001). In the 1st month follow-up, there was a significant improvement in median IPSS in both age groups (23 to 10 years in the younger group and from 19 to 16 in the elderly group; P < 0.001 and P = 0.01, respectively), while the elderly group’s IPSS was significantly higher than the younger group’s (16 vs 10; P = 0.01).…”

“…The study of Majumdar et al reported that the most common perioperative complications in the ≥75 age group were dysuria (10.2%), urinary tract infection (10.2%), and haematuria (10.2%). 24 They detected no significant difference between age groups in perioperative complications.…”

“…There was a significant difference in terms of general health perceptions, impact on life, emotions, and sleep/energy at 1, 3, and 6 months after HoLEP compared to baseline scores (p<0.05). <75: 62 69.2±4.2 65±27 5.9±4.6 18.9±8.6 8.7±3.4 6.1±1.0 4±0.5 90±30 3.9±2.6 19.3±9.8 Majumdar et al 2014 24 prospective KTP 80–180 W PVP <75: 153 N/A N/A 2.3 (1.4–4) 19 (14–24) N/A 4 0 N/A Δ 5.5 b (1st Month) N/A In the 1st month follow-up, there was a significant improvement in median IPSS in both age groups (23 to 10 years in the young group and from 19 to 16 in the elderly group; P < 0.001 and P = 0.01, respectively), while the IPSS score in the elderly group was found to be significantly higher than the younger group (16 vs 10; P = 0.01). They found no significant difference between age groups in terms of perioperative complications.…”

“… 6 , 22–24 Five studies focussed mainly on Holmium laser enucleation of the prostate (HoLEP). 6 , 17 , 20–22 One study focussed on comparing HoLEP to other laser prostatectomy procedures, 16 two studies examined Thulium laser enucleation of the prostate (ThuLEP) in more detail, 14 , 18 and two other studies focussed on the GreenLight XPS 180-W laser procedure, 19 , 23 one focussed on potassium-titanyl-phosphate (KTP) laser 24 and another compared laser prostatectomy to transurethral resection of the prostate (TURP). 15 …”

“… 14 In the study by Majumdar et al, heart disease, haematuria and use of anticoagulants were more common in ≥75 age group than their younger group (p=0.03, p=0.05, p=0.002). 24 Anan et al reported that comorbidities were more likely in groups aged ≥75 years. 22 There was no significant difference between groups in AC therapy, (21% vs 34%; p= 0.16).…”