Is thulium laser vapoenucleation of the prostate equally safe and effective in elderly patients? A propensity score matched analysis of early perioperative and functional outcomes

PURPOSE

To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to "younger" patients.

MATERIALS AND METHODS

We performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients ≤75 years-old; Group B included patients >75 years-old. Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up.

RESULTS

After propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, P-value <.001). No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared. Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions.

CONCLUSIONS

In our hands, even in elderly patients affected by BPH, ThuVEP appears to be a safe and effective treatment option.

Is thulium laser vapoenucleation of the prostate equally safe and effective in elderly patients? A propensity score matched analysis of early perioperative and functional outcomes

PURPOSE

To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to "younger" patients.

MATERIALS AND METHODS

We performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients < 75 years-old; Group B included patients > 75 years-old. Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up.

RESULTS

After propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, p-value < 0.001). No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared. Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions.

CONCLUSIONS

In our hands, even in elderly patients affected by BPH, ThuVEP appears to be a safe and effective treatment option.

[Frailty as a predictor of mortality in a cohort of people aged 75 years and older]

OBJECTIVE

To determine the association between frailty in older persons and mortality in the city of Lleida (Spain) between 2009 and 2012.

METHODS

We conducted a prospective longitudinal study based on persons living in the city of Lleida aged 75 years and older, covered by the public health system and living in single-family households. The cross-sectional study was performed between 2009 and 2010 and longitudinal study was carried out 3 years later (median 25 months).

RESULTS

Survival was lower in frail individuals than in pre-frail and non-frail individuals (log rank=10.56; p=0.005). In addition to frailty (HR=4.95; 95%CI: 1.71-14.31). Age was also a significant predictor (HR=2.87; 95%CI: 1.02-8.26).

CONCLUSION

A higher level of frailty was associated with an increased risk of death at 2 years in a prospective cohort of elderly persons older than 75 years living in their own homes in the city of Lleida.