Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada.
Urology. 2013 Mar;81(3):634-9. doi: 10.1016/j.urology.2012.11.042. Epub 2013 Jan 16.
To evaluate the morbidity and perioperative outcome of different laser prostate techniques among octogenarians.
We performed a retrospective review of our prospectively maintained laser prostate surgery database between 1998 and 2012. We identified 264 octogenarians (16.5%) who underwent laser prostate surgery. Perioperative morbidity and mortality in addition to the functional outcome of these procedures were assessed. Risk factors and predictors of the outcome were analyzed.
The mean age at time of procedure was 84 ± 3.5 years. Holmium laser enucleation of the prostate was done in 171 (64.7%), holmium laser ablation of the prostate in 16 (6%), holmium laser transurethral incision of the prostate in 13 (5%) and photoselective vaporization of the prostate in 64 (24.3%). Procedures for octogenarians increased from 11% at the end of 2002 to 19% at 2012. A total of 68 perioperative complications occurred in 52 procedures (19.6%), without any perioperative deaths. There were 56 (82.3%) low-grade complications (Clavien grade I-II) and 12 (17.7%) high-grade complications (Clavien grade ≥ III). A longer operating time was an independent risk factor for perioperative morbidity on multivariate analysis. Significant improvement of symptoms score (International Prostate Symptom Score-Quality of Life) associated with objective improvement of urine flow parameters (maximum flow [Q-max] and postvoid residual) were reported at different follow-up assessments in the first year (P <.05). Persistent urge or stress incontinence, or both, were found in 4 (1.5%). Total urinary incontinence occurred in 1 patient, with neurologic deficit as the underlying cause. De novo urethral stricture was reported in 8 patients (3%).
Octogenarians undergoing laser prostate surgery for treatment of benign prostate hyperplasia have limited perioperative morbidity. Laser prostate surgery can achieve good functional outcome and maintain quality of life of seniors. Furthermore, it is safe in seniors with a high morbidity index; however, longer operating time is an independent risk factor for perioperative morbidity.
评估 80 岁以上老年人不同激光前列腺技术的发病率和围手术期结果。
我们对 1998 年至 2012 年期间前瞻性维护的激光前列腺手术数据库进行了回顾性分析。我们确定了 264 名 80 岁以上（16.5%）接受激光前列腺手术的患者。评估了这些手术的围手术期发病率和死亡率以及功能结果。分析了结果的危险因素和预测因素。
手术时的平均年龄为 84±3.5 岁。钬激光前列腺剜除术 171 例（64.7%），钬激光前列腺切除术 16 例（6%），钬激光经尿道前列腺切开术 13 例（5%），前列腺光选择性汽化术 64 例（24.3%）。80 岁以上患者的手术数量从 2002 年底的 11%增加到 2012 年的 19%。52 例（19.6%）共发生 68 例围手术期并发症，无围手术期死亡。低级别并发症（Clavien 分级 I-II）56 例（82.3%），高级别并发症（Clavien 分级≥III）12 例（17.7%）。多因素分析显示，手术时间较长是围手术期发病率的独立危险因素。在术后第 1 年的不同随访评估中，报告了症状评分（国际前列腺症状评分-生活质量）显著改善与客观尿流参数（最大流量[Q-max]和残余尿量）改善相关（P<.05）。4 例（1.5%）存在持续性急迫或压力性尿失禁或两者兼有。1 例患者发生完全性尿失禁，其潜在病因是神经功能缺损。8 例（3%）患者出现新发尿道狭窄。
接受激光前列腺手术治疗良性前列腺增生的 80 岁以上老年人围手术期发病率有限。激光前列腺手术可获得良好的功能结果并维持老年人的生活质量。此外，它在发病率较高的老年人中是安全的；然而，手术时间较长是围手术期发病率的独立危险因素。
