Transurethral Laser Surgery for Benign Prostate Hyperplasia in Octogenarians: Safety and Outcomes

OBJECTIVE To evaluate the morbidity and perioperative outcome of different laser prostate techniques among octogenarians. METHODS We performed a retrospective review of our prospectively maintained laser prostate surgery database between 1998 and 2012. We identified 264 octogenarians (16.5%) who underwent laser prostate surgery. Perioperative morbidity and mortality in addition to the functional outcome of these procedures were assessed. Risk factors and predictors of the outcome were analyzed. RESULTS The mean age at time of procedure was 84 +/- 3.5 years. Holmium laser enucleation of the prostate was done in 171 (64.7%), holmium laser ablation of the prostate in 16 (6%), holmium laser transurethral incision of the prostate in 13 (5%) and photoselective vaporization of the prostate in 64 (24.3%). Procedures for octogenarians increased from 11% at the end of 2002 to 19% at 2012. A total of 68 perioperative complications occurred in 52 procedures (19.6%), without any perioperative deaths. There were 56 (82.3%) low-grade complications (Clavien grade I-II) and 12 (17.7%) high-grade complications (Clavien grade >= III). A longer operating time was an independent risk factor for perioperative morbidity on multivariate analysis. Significant improvement of symptoms score (International Prostate Symptom Score-Quality of Life) associated with objective improvement of urine flow parameters (maximum flow [Q-max] and postvoid residual) were reported at different follow-up assessments in the first year (P <.05). Persistent urge or stress incontinence, or both, were found in 4 (1.5%). Total urinary incontinence occurred in 1 patient, with neurologic deficit as the underlying cause. De novo urethral stricture was reported in 8 patients (3%). CONCLUSION Octogenarians undergoing laser prostate surgery for treatment of benign prostate hyperplasia have limited perioperative morbidity. Laser prostate surgery can achieve good functional outcome and maintain quality of life of seniors. Furthermore, it is safe in seniors with a high morbidity index; however, longer operating time is an independent risk factor for perioperative morbidity. UROLOGY 81: 634-639, 2013. (c) 2013 Elsevier Inc.