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01-04-2013 | Article

Holmium laser enucleation of the prostate effective in all ages

Abstract

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medwireNews: Holmium laser enucleation of the prostate (HoLEP) seems to be a well tolerated and effective treatment option for individuals with benign prostatic hyperplasia (BPH), regardless of what age they are, report researchers.

In a retrospective analysis of 311 patients who underwent HoLEP for lower urinary tract symptoms (LUTS), the overall morbidity rates, length of hospital stay, and 1-year functional outcomes were similar across all age groups, report Mitchell Humphreys (Mayo Clinic, Phoenix, Arizona, USA) and colleagues in BJU International.

"One of the most appealing benefits of HoLEP is its associated low morbidity," say the researchers. "Various series have found HoLEP to have low incidence of perioperative and late complications." However, the impact of age stratification on the efficacy and morbidity of HoLEP has not been considered until now, they add.

Using the modified Clavien classification system to categorize complications, the team found that the overall morbidity rates were similar between all decades of age, at 20.0%, 24.4%, 21.6% and 22.1% in those aged 50-59 years (group 1), 60-69 (group 2), 70-79 (group 3), and 80 years or older (group 4).

The incidence of significant complications (Clavien grade ≥3) were minimal and again similar regardless of patients' age, at 0.0%, 5.6%, 3.9%, and 4.4% for age groups 1 through 4, respectively.

There were also no significant differences in the length of hospital stay across the age brackets, at 1.18, 1.28, 1.26, and 1.68 days across groups 1 through 4, and no between-group differences in the mean change of hemoglobin levels.

At the 6-week and 1-year follow ups, all groups showed improvement in their LUTS, as assessed by the International Prostate Symptom Score, maximum urinary flow rate (Qmax), and post-void residual urine volume (PVR), with no significant differences observed between age groups. Assessment of urinary incontinence using the International Consultation on Incontinence Questionnaire Short-Form also showed no significant between-group differences at 1 year.

"The overall morbidity and functional outcomes at 1 year were similar across all decades of adult life in patients treated with HoLEP for BPH," write Humphreys and team.

The researchers add that, compared with data on traditional transurethral resection of the prostate, the present data suggest that HoLEP confers a broader margin of safety with less morbidity for elderly patients.

By Sally Robertson, medwireNews Reporter