Are Outcomes of Thulium Laser Enucleation of the Prostate Different in Men Aged 75 and Over? A Propensity Score Analysis

• Published in: Urology (Ridgewood, N.J.) Vol. 132; pp. 170 - 176
• Main Authors: Castellani, Daniele, Pirola, Giacomo Maria, Gasparri, Luca, Pucci, Michele, Di Rosa, Mirko, Carcano, Giulio, Saredi, Giovanni, Dellabella, Marco
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2019
• Subjects: Age Factors; Aged; Aged, 80 and over; Humans; Lower Urinary Tract Symptoms - etiology; Lower Urinary Tract Symptoms - surgery; Male; Middle Aged; Propensity Score; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - surgery; Retrospective Studies; Thulium - therapeutic use; Transurethral Resection of Prostate - methods; Treatment Outcome
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2019.06.025

To evaluate the outcomes of thulium laser enucleation of the prostate (ThuLEP) in men aged ≥75 years compared to youngers. Traditional surgery has increased and significant morbidity in older men. Lasers have been introduced as an alternative approach to overcome the morbidity of traditional surgery.
We retrospectively evaluated 412 men who underwent en bloc ThuLEP. Inclusion criteria were lower urinary tract symptoms refractory to medical therapy, maximum urinary flow rate (Qmax) ≤15 mL/s, International Prostate Symptom Score (IPSS) ≥8 and absolute indications for surgery. Prostate volume, prostate specific antigen, IPSS, and Qmax, antiplatelet/anticoagulant therapy, ASA score, operation time, length of catheterization, discharge day, early complications, and reoperations were gathered. Differences between groups were estimated using propensity scores, by fitting a stepwise logistic regression model with age group as the dependent variable.
One hundred twenty-nine patients were aged ≥75 years (Group 2). Mean age was 65.6 ± 6.0 years in Group 1 and 79 ± 3.7 years in Group 2. Propensity scores retrieved 206 patients. Median operation, catheterization time, and hospital stay were similar in both groups (55 minutes, 2 and 3 days). Overall, 85.9% of men had no complications, with no differences between the groups (82.5% in Group 1 and 89.3% in Group 2). The incidence of Clavien grade III-IV complications was comparable (3.8% in Group 1, 1% in Group 2). By 1 year, there were no statistically significant differences in IPSS, Qmax, QoL, or reoperation rate between the groups.
En bloc ThuLEP is a safe and effective treatment even in men aged ≥75 years old.