Presented by: Christopher Connors BA
Icahn School of Medicine at Mount Sinai

Introduction

The safety of surgical options for benign prostatic hyperplasia (BPH) in octogenarians (OGN) is not fully understood. This is the first study to compare post-operative outcomes of transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), and laser enucleation of the prostate (LEP) among OGNs using a national database. 

Materials

The NSQIP database was queried from 2013 to 2019 for males undergoing TURP, PVP, and LEP. Patients were grouped as OGN or younger (< 80 years old) and stratified by procedure. Demographics and 30-day surgical outcomes including surgery-related readmissions (SRR), prolonged length of stay (PLOS), and Clavien-Dindo (CD) complications were analyzed using chi-square and multivariate analysis.

Results

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71,283 BPH cases were identified (TURP = 47,704; PVP = 18,539; LEP = 5,040). OGNs were more likely to experience SRR, CD I/II, and bleeding requiring transfusion (BRT) for all BPH procedures when compared to younger patients. OGNs undergoing TURP or PVP were also more likely to experience PLOS, CD IV, and urinary tract infections. On multivariate analysis for TURP and PVP, being an OGN was a predictor of SRR (TURP: OR = 1.289; PVP: OR = 1.483), PLOS (OR = 1.554; 1.794), CD I/II (OR = 1.290; 1.297), and CD IV (OR = 1.230; 1.797), all p < 0.05 [Table 1]. However, for LEP, OGN classification was not a significant risk factor for any surgical outcomes studied. Among OGNs only, PVP was an independent risk factor for CD IV (OR = 1.511) and sepsis (OR = 1.684) but a negative predictor of SRR (OR = 0.615), PLOS (OR = 0.370), and BRT (OR = 0.377) when compared to TURP, all p < 0.05 [Table 2]. Compared to TURP, LEP was a negative predictor of PLOS (OR = 0.386), CD I/II (OR = 0.611), and CD IV (OR = 0.380), all p < 0.05. 

Conclusion

LEP is used less frequently than TURP or PVP but demonstrates a more favorable safety profile for OGNs undergoing BPH surgery. Further studies are needed to confirm the safest BPH surgical options for OGNs given the advent of new procedures.

Funding

None

Co-Authors

Micah Levy, BS
Icahn School of Medicine at Mount Sinai

Juan Sebastian Arroyave, BS
Icahn School of Medicine at Mount Sinai

Evan Garden, MD
Icahn School of Medicine at Mount Sinai

Olamide Omidele, MD
Icahn School of Medicine at Mount Sinai

Francisca Larenas, MD
Icahn School of Medicine at Mount Sinai

Michael Palese, MD
Icahn School of Medicine at Mount Sinai