2162 A PROSPECTIVE RANDOMIZED TRIAL COMPARING TRANSURETHRAL HOLMIUM LASER ENUCLEATION OF THE PROSTATE WITH TRANSURETHRAL ELECTROCAUTERY RESECTION OF THE PROSTATE FOR THE TREATMENT OF BLADDER OUTLET OBSTRUCTION SECONDARY TO BENIGN PROSTATIC HYPERPLASIA IN LARGE GLANDS

Autor: Ashraf Aggour, Enmar Habib, Mohammed El Gammal, Sherif Abd El Rahman, Hosni Salem
Rok vydání: 2012
Předmět:
Zdroj: Journal of Urology. 187
ISSN: 1527-3792
0022-5347
DOI: 10.1016/j.juro.2012.02.2335
Popis: the first age stratified assessment of outcomes following HOLEP. METHODS: A total of 311 patients underwent HOLEP for obstructive voiding symptoms from August 2007 to June 2011. We retrospectively analyzed the perioperative outcomes and morbidity between patients age 50 – 59, 60 – 69, 70 – 79, and 80 years old. Thirty-day complications were stratified using the Clavien classification system. RESULTS: In our study cohort 22 patients were between the ages 50 – 59, 91 patients were between 60 – 69, 153 patients were between 70 – 79, and 45 patients were 80 years old. There were no differences in the pre-operative ASA score between the four groups. There was a significant difference in the mean body mass index (BMI) (29.8, 28.9, 27.2, 25.8; cm/kg, p 0.001), resected prostate weight (30.3, 44.5, 60.3, 56.6, g, p 0.0026), and enucleation time (39.4, 56.7, 63, 63.8, min, p 0.001). Blood loss during surgery was evaluated by the difference between the pre-operative hemoglobin and the immediate post-operative hemoglobin. There was no significant difference in the mean hemoglobin change (1.22, 1.42, 1.57, 1.78, g/dL, p 0.1799) or transfusion incidence (9%, 2%, 3.2%, 11%) between the age groups. Mean length of hospital stay was, 1.18, 1.28, 1.26, 1.68, days, p 0.1116. The mean duration of the foley catheter after surgery was twice as long in patients 80 years compared to those younger than 60 years (1.68, 2.62, 2.44, 3.4, p 0.089). The overall morbidity was similar between the two groups (20%, 24.4%, 21.6%, 22.1%). The incidence of significant complications (Clavien grade III) was also similar (0%, 5.6%, 3.9%, 4.4%, p 0.89). After adjusting for BMI, resected prostate weight, and enucleation time, age was not found to be an independent predictor of morbidity. CONCLUSIONS: Patients in their 70s and those 80 and older had longer enucleation times and larger prostates, though the transfusion rate and blood loss was similar in all age groups. Overall morbidity and hospital stay was also similar between all age groups. Age was not found to be a predictor of complications following HOLEP. This study shows that HOLEP is a safe and effective treatment option regardless of prostate size or patient age and should be considered as an option for the symptomatic octogenarian patient.
Databáze: OpenAIRE
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