Age‐stratified outcomes of holmium laser enucleation of the prostate

• Published in: BJU international Vol. 112; no. 7; pp. 982 - 989
• Main Authors: Mmeje, Chinedu O., Nunez‐Nateras, Rafael, Warner, Jonathan N., Humphreys, Mitchell R.
• Format: Journal Article
• Language: English
• Published: Oxford Wiley-Blackwell 01.11.2013; Wiley Subscription Services, Inc
• Subjects: Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; BPH; enucleation; Gynecology. Andrology. Obstetrics; holmium; Humans; laser; Laser Therapy; Lasers, Solid-State - therapeutic use; Lower Urinary Tract Symptoms - etiology; Lower Urinary Tract Symptoms - surgery; Male; Male genital diseases; Medical research; Medical sciences; Middle Aged; Morbidity; Nephrology. Urinary tract diseases; Older people; prostate; Prostatectomy - methods; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - surgery; Retrospective Studies; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Nephrology; Urinary system disease; Prognosis; Prostate disease; Urology; Enucleation; Holmium; Laser; Benign prostatic hyperplasia; Benign neoplasm; BPH; Urogenital system; Male genital diseases; Prostate; Age; prostate; laser; enucleation; holmium
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.12063

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 ≥80 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 ≥80 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 ≥ III), change in serum haemoglobin level, and length of hospital stay. Patients ≥80 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.