Presented by: Nicholas Dean MD
Northwestern University

Introduction

Patients ≥ 90-years-old with symptomatic BPH are often not offered surgical intervention based on safety concerns regarding their advanced age. For many of these men, indwelling or intermittent catheterization are the only recommended treatment options. The objective of our study was to examine the safety and efficacy of HoLEP in ≥ 90-year-old patients.

Materials

We retrospectively identified men aged ≥ 90 who underwent HoLEP from our BPH database and compared them to HoLEP controls. All HoLEP procedures were performed with MOSES 2.0 laser technology. Descriptive statistics and two-tailed T-Tests were performed with SPSS (p<0.05).

Results

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Overall, we identified 16 men aged ≥ 90 who underwent HoLEP between March 2021 to February 2023 at our institution. The mean patient age was 92.4 years (range: 90-97) and the mean pre-operative prostate volume was 127.9mL. Most patients required pre-operative catheterization for urinary retention (13/16, 81.3%) and half had a history of recurrent urinary tract infections (8/16, 50.0%). Almost half of these patients were therapeutically anti-coagulated (AC) (7/16, 43.8%). Only a minority of the patients were candidates for same-day trial of void and were discharged on the same-day of their operation (2/16, 12.5%). Mean length of stay (LOS) was 27.7 hours and mean catheter duration was 1.25 days. When comparing the ≥ 90 baseline characteristics to HoLEP controls (n=781), the ≥ 90 cohort had a higher rate of cognitive-impairment, history of pre-op UTI’s, pre-op AC, ASA score, and lower BMI (all p<0.05). There was no difference between the groups in regards to procedural time, pathologic specimen weight, post-operative AUASS, MISI score, rate of ER presentations, re-admissions, or 90-day complications (all p>0.05). There were no 90-day mortalities in the aged ≥ 90 cohort, but at a mean follow-up of 9.6 months, 3/16 (18.8%) patients have died from unrelated causes. All living patients aged ≥ 90 years-old are currently free from catheterization.

Conclusion

HoLEP can be a safe and effective surgical treatment option for motivated patients ≥ 90-years-old that are deemed fit to undergo a general or spinal anesthetic. Patient functional and safety outcomes after HoLEP were maintained regardless of patient age.

Funding

None

Co-Authors

Jenny Guo, MD
Northwestern University

Clarissa Wong, MD
Northwestern University

Perry Xu, MD
Northwestern University

Amy Krambeck, MD
Northwestern University