Endoscopic enucleation of the prostate in men aged 80 years and older. Outcomes from a global, large, and multicenter series using different energy sources and techniques.

PURPOSE

To provide the outcomes from a multicentric series of men aged 80 years and above, understand the feasibility of endoscopic enucleation of the prostate (EEP), and compare different energy sources and techniques.

METHODS

We extracted data on patients who underwent EEP in 15 Centers (January 2019-January 2023). Continuous variables are expressed as medians and interquartile ranges while categorical variables as absolute numbers and percentages. A multivariable logistic regression analysis was performed to identify predictors of overall postoperative incontinence and reported as odds ratio (OR) and 95% confidence interval (CI).

RESULTS

731 patients were included. Median age was 82 years and median prostate volume (PV) was 90 cc. 33.1% of participants had PV ≤ 80 ml, 28.4%. between 81 and 100 ml, 36.7% between 101 and 200 ml, and 1.8% of more than 200 ml. Median International Prostate Symptom Score was 23 [20-26]. EEP was mainly performed with the en-bloc technique (367 cases, 50.3% of the total). Total median operation time was 80 min [60-110]. Postoperative urinary incontinence was reported in 113 patients (15.5%). Complication rate was low with only 16 patients (2.2%) suffering from major complications (sepsis: 1 case; bleeding requiring surgical control: 13 cases; secondary morcellation: 2 cases). At multi-variable analysis, PV > 200 ml was significantly associated with higher odds of incontinence (OR 5.84 95% CI 1.76-18.96), whilst en-bloc enucleation with lower odds (OR 0.51 95% CI 0.32-0.80).

CONCLUSION

EEP in men aged 80 years and above is a safe, efficacious, and size-independent procedure. In glands larger than 200 ml there may be a prolonged period of incontinence, mainly stress-related. En-bloc enucleation may be a better approach to minimize early urinary incontinence.