Presented by: Sagi A. Shpitzer MD
Rabin Medical Center

Introduction

Introduction: Holmium laser enucleation of the prostate (HoLEP) is a relatively new surgical technique used for treating benign prostatic obstruction. The increasing experience in this technique has made it possible for older and frailer patients, who were previously considered non-operative candidates, to undergo HoLEP more frequently. This study aims to analyze the characteristics and clinical outcomes of HoLEP in the octogenarian population.

Materials

Methods: We conducted a retrospective analysis of all HoLEP surgeries performed at our institution between 2016 and 2022. We compared clinical, demographic, and surgical parameters between patients aged 80 and above and those below the age of 80.

Results

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Results: The study included 704 patients, of whom 113 were aged 80 and above and 591 were younger patients. The median age in the elderly group was 83 years (IQR = 81-86 years) and in the younger group was 70 years (IQR = 65-74 years). Preoperatively, the elderly group had a larger prostate volume (118 vs. 110 ml, p=0.03) and a higher likelihood of having an indwelling catheter (65% vs. 40%, p<0.001). Despite the larger prostate size operative time did not differ between the groups (118 vs. 115 minutes, p=0.36) although the elderly patients were more likely to undergo surgery under spinal anesthesia (14.2% vs. 7.5%, p=0.02). On the first postoperative day elderly patients had a lower catheter-free rate (75% vs. 85%, p=0.01), but the rates of catheter-free discharge were similar between the elderly and the younger group (94.7% vs. 97.2%, p=0.18). During the 30-day follow-up period, there was no significant difference in emergency room visits (9.5% vs. 10.6%, p=0.71) or hospital readmissions (6.8% vs. 9.7%, p=0.27) between the two groups.

Conclusion

Conclusions: HoLEP in octogenarian patients yields comparable results to those of younger patients, with similar catheter-free rates on discharge, despite a higher rate of indwelling catheterization preoperatively. Age alone should not be a factor for excluding this population from undergoing HoLEP surgery.

Funding

None

Co-Authors

Abd E. Darawsha, MD
Rabin Medical Center

David Lifshitz, MD
Rabin Medical Center

Gherman Creiderman, MD
Rabin Medical Center

Ron Gilad, MD
Rabin Medical Center

Michael Frumer, MD
Rabin Medical Center

Tzach Aviv, MD
Rabin Medical Center

Muhammad Krenawi, MD
Rabin Medical Center

Tomer Weizman, MD
Rabin Medical Center

Shayel Bercovich, MD
Rabin Medical Center

Nadav Dekel, MD
Rabin Medical Center

Hadar Tamir, MD
Rabin Medical Center

Tal Wax, MD
Rabin Medical Center

Tomer Hasdai, MD
Rabin Medical Center

Yossi Ventura, MD
Rabin Medical Center

Niv Segal, MD
Rabin Medical Center

Hen Hendel, MD
Rabin Medical Center

Liran Zieber, MD
Rabin Medical Center

Dmitry Enikeev, MD
Medical University of Vienna

Yaron Ehrlich, MD
Rabin Medical Center