Evaluation of the effectiveness and safety of laser enucleation of the prostate in different age groups.

Abstract

Introduction. The influence of the age phenomenon on the outcome of the surgical treatment of benign prostate hyperplasia (BPH) research is insufficient. Considering the wide use of the more advanced laser enucleation method in the surgical treatment of BPH, there is a need to evaluate the efficiency and safety of this technique among aged patients compared to younger age groups. In this review the task was to evaluate the impact of the age phenomenon on the result of treatment, using the available scientific literature. Materials and methods. Articles were searched in three databases (Pubmed, Scopus and Web of Science) using the following request: «laser enucleation», «prostate», «elderly patients», «older patients» and «age». The unsystematic review of 7 works in English containing original data demonstrated the results of different types of enucleation among the patients with a clear stratification of groups by age for the period 2013-2022 was made. Results. Тhe absolute majority of studies do not show significant differences between the age groups regarding the preoperative IPSS, Qmax, post-void residual (PVR), however, a high frequency of chronic diseases in the older age group is noticed. In most studies, no significant differences in a number of complications according to Clavien-Dindo were found. Only in one study P. Gild et al., where large samples were researched, the frequency of blood transfusions and a number of complications ≥3b, were much higher in a group of patients over 80 y.o. and older comparing to younger-aged groups: 0 (0%), 8 (1,3%), 22 (2,7%), 14 (8,2%) for the group under 60 years old, 60-69 years old, 70-79 years old, 80 years and older, respectively (p<0,001); 2 (1,5%), 12 (1,9%), 34 (3,9%), 13 (7,1%), for these groups, respectively (p=0,02). Regarding the postoperative Qmax, despite of significant improvement of this indicator in all age groups, worse results are noticed in older patients group comparing to the results of patients in younger groups. However, the tendency to balance the marked differences with a long observation period is also noticed. Conclusions. Laser enucleation of the prostate is the effective and safe method for prostatic hyperplasia treatment for the patients of any age. However, available data about bad results after the surgical treatment among elderly patients and a higher frequency of complications show the need of the further research of this topic and evaluation of the surgical treatment at an earlier age.