Int Neurourol J.  2016 Jun;20(2):143-150. 10.5213/inj.1630478.239.

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

• Piao S
• Choo MS
• Kim M
• Jeon HJ
• Oh SJ

• KMID: 2365746
• DOI: http://doi.org/10.5213/inj.1630478.239

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.

Keyword

Laser Therapy; Prostate; Prostatic Hyperplasia; Transurethral Resection of Prostate

MeSH Terms

Aged
Holmium*
Humans
Hypertension
Incidence
Laser Therapy
Lasers, Solid-State*
Length of Stay
Morcellation
Preoperative Period
Prospective Studies*
Prostate*
Prostatic Hyperplasia
Quality of Life
Transurethral Resection of Prostate
Urinary Retention
Holmium