Daniele Castellani1, Giacomo Maria Pirola2, Luca Gasparri3, Michele Pucci3, Mirko Di Rosa4, Giulio Carcano5, Giovanni Saredi6, Marco Dellabella3. 1. Department of Urology, IRCCS-INRCA, Ancona, Italy. Electronic address: d.castellani@inrca.it. 2. Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy. 3. Department of Urology, IRCCS-INRCA, Ancona, Italy. 4. Geriatric Pharmacoepidemiology Lab, IRCCS-INRCA, Ancona, Italy. 5. Department of General Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. 6. Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Abstract
OBJECTIVE: 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/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. 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. 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. CONCLUSION: En bloc ThuLEP is a safe and effective treatment even in men aged ≥75 years old.
OBJECTIVE: 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/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. 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. 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. CONCLUSION: En bloc ThuLEP is a safe and effective treatment even in men aged ≥75 years old.
Authors: David Bouhadana; David-Dan Nguyen; Xinyan Zhang; Jialin Mao; Dean S Elterman; Alexis E Te; Kevin C Zorn; Naeem Bhojani; Art Sedrakyan; Bilal Chughtai Journal: World J Urol Date: 2021-07-07 Impact factor: 4.226
Authors: Thomas R W Herrmann; Stavros Gravas; Jean Jmch de la Rosette; Mathias Wolters; Aristotelis G Anastasiadis; Ioannis Giannakis Journal: J Clin Med Date: 2020-05-10 Impact factor: 4.241