Transurethral resection of the prostate in the extreme elderly (≥ 85 years): treatment success, morbidity and survival.

Introduction: There are few studies evaluating the outcomes associated with transurethral resection of the prostate (TURP) in extremely elderly men. Our objective was to assess the safety and efficacy of this procedure in this special population.

Methods: As part of an ethically approved study, retrospective review was carried out of all patients ≥ 85 years who underwent TURP between 2014 and 2023 at a tertiary centre. Data was collected on demographics including frailty status, operative data and complications. Treatment success was defined as catheter free status.

Results: Over the study period, 194 patients (median age 87 years, IQR 86-89) underwent TURP, with a median follow-up of 6 years (IQR 3.5-8). The majority (68%) were ASA 3. 28% received home nursing assistance or were nursing home residents at the time of surgery. Median CCI score was 2 (IQR 1-3). 66% used anticoagulant medication. 97% received spinal anaesthesia and median operative time was 63 min (IQR 39-88). The intra-operative complication rate was 2.6%. The 30-day complication rate was 30% (Clavien-Dindo (CD) 1-2: 24%, ≥ CD 3: 5.7%). Among those with a catheter preoperatively (62%, n = 120), 84% had achieved spontaneous voiding (n = 101) at three month follow up. Overall, 93% were still alive at 1 year post surgery. The cumulative reoperation rate during study follow up was 7.2% at 1 year, 10.9% at 3 years, and 11.5% at 5 years.

Conclusion: Treatment success for TURP in extremely elderly men (≥ 85 years) is high, but the associated morbidity burden warrants the need for an individualised approach when considering men in this special population who are potential candidates for surgery.