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Are outcomes of Thulium Laser Enucleation of the prostate different in men aged 75 and over? A propensity score analysis

  • Daniele Castellani,
  • Giacomo Maria Pirola,
  • Luca Gasparri,
  • Michele Pucci,
  • Mirko Di Rosa,
  • Giulio Carcano,
  • Giovanni Saredi,
  • Marco Dellabella
Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy Department of Urology, IRCCS-INRCA, Ancona, Italy Geriatric Pharmacoepidemiology Lab, IRCCS-INRCA, Ancona, Italy Department of General Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy

Publication: Urology, June 2019

DOI: doi.org/10.1016/j.urology.2019.06.025





Objectives

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.

Material

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/sec, International Prostate Symptom Score (IPSS) ≥8 and absolute indications for surgery. Prostate volume, PSA, 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 (PS), by fitting a stepwise logistic regression model with age group as the dependent variable.

Results

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. PS 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.

Conclusions

En bloc ThuLEP is a safe and effective treatment even in men aged ≥75 years old.