Top

Published in:

01-12-2021 | Benign Prostatic Hypertrophy | Original Article

Safety and efficacy of TURP vs. laser prostatectomy for the treatment of benign prostatic hyperplasia in multi-morbid and elderly individuals aged ≥ 75

Authors: David Bouhadana, David-Dan Nguyen, Xinyan Zhang, Jialin Mao, Dean S. Elterman, Alexis E. Te, Kevin C. Zorn, Naeem Bhojani, Art Sedrakyan, Bilal Chughtai

Published in: World Journal of Urology | Issue 12/2021

Abstract

Purpose

To compare the safety and durability of transurethral resection of the prostate (TURP) and Laser prostatectomy (LP) among multi-morbid and elderly patients.

Methods

Using data retrieved from the New York State Department of Health Statewide Planning and Research Cooperative System and the California Office of Statewide Health Planning and Development, we selected cohorts of 1) multi-morbid (Charlson comorbidity index ≥ 3) and 2) elderly (aged ≥ 75) patients with benign prostatic hyperplasia who underwent laser coagulation, vaporization, enucleation, or TURP between January 2005 and December 2016. We assessed the post-operative incidence of hospital readmission and ER visit at 30 days and 90 days, complications at 90 days, and reoperation and the development of urethral stricture at 6 months or longer.

Results

We found 12,815 and 29,806 patients in the multi-morbid and elderly cohort, respectively. Compared to LP, TURP was associated with lower odds of 90-day hospital readmission and ER visit in the multi-morbid cohort (OR 0.92, 95% CI 0.85–1.00) and higher odds in the elderly cohort (OR 1.07, 95% CI 1.01–1.14). The multi-morbid cohort showed lower odds of urinary tract infections (Ref: LP, OR 0.83, 95% CI 0.73–0.93). The elderly cohort showed higher odds of experiencing hematuria (OR 1.28, 95% CI 1.03–1.59) post TURP. TURP was associated with a 19% (95% CI 0.66–1.00) and 20% (95% CI 0.71–0.91) reduced hazard of reoperation at 6 months or longer for multi-morbid and elderly cohorts, respectively.

Conclusion

Compared to LP, TURP was associated with higher complication rates for the multi-morbid and elderly cohorts overall but a lower hazard of reoperation, supporting its durability.

McVary KT (2006) BPH: epidemiology and comorbidities. Am J Manag Care 12:S122–S128PubMed

Kailavasan M, Berridge C, Athanasiadis G et al (2020) Design, implementation, and evaluation of a novel curriculum to teach transurethral resection of the prostate (TURP): a 3-year experience of urology simulation bootcamp course. World J Urol. https://doi.org/10.1007/s00345-020-03104-3CrossRefPubMed

Castellani D, Pirola GM, Gasparri L et al (2019) Are outcomes of thulium laser enucleation of the prostate different in men aged 75 and over? A propensity score analysis. Urology 132:170–176. https://doi.org/10.1016/j.urology.2019.06.025CrossRefPubMed

Watt J, Tricco AC, Talbot-Hamon C et al (2018) Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis. BMC Med 16:1–14. https://doi.org/10.1186/s12916-017-0986-2CrossRef

Hoffman C, Rice D, Sung H-Y (1996) Persons with chronic conditions: their prevalence and costs. JAMA 276:1473–1479CrossRefPubMed

Fried LP, Ferrucci L, Darer J et al (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 59:M255–M263CrossRef

Van Iersel MB, Olde Rikkert MG (2006) Frailty criteria give heterogeneous results when applied in clinical practice. J Am Geriatr Soc 54:728–729CrossRefPubMed

Anderson BB, Heiman J, Large T et al (2019) Trends and perioperative outcomes across major benign prostatic hyperplasia procedures from the ACS-NSQIP 2011–2015. J Endourol 33:62–68CrossRefPubMed

Becher K, Madersbacher S, Michel M et al (2020) Management of geriatric patients with benign prostatic hyperplasia. Urologe A 59:1195–1203. https://doi.org/10.1007/s00120-020-01311-9CrossRefPubMed

10.

Suskind AM (2017) Frailty and lower urinary tract symptoms. Curr Urol Rep 18:1–6. https://doi.org/10.1007/s11934-017-0720-9CrossRef

11.

Thomas JA, Tubaro A, Barber N et al (2016) A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur Urol 69:94–102. https://doi.org/10.1016/j.eururo.2015.07.054CrossRefPubMed

12.

Lai S, Peng P, Diao T et al (2019) Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies. BMJ Open 9:e028855. https://doi.org/10.1136/bmjopen-2018-028855CrossRefPubMedPubMedCentral

13.

Bachmann A, Tubaro A, Barber N et al (2014) 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial—the GOLIATH study. Eur Urol 65:931–942CrossRefPubMed

14.

Austin SR, Wong Y-N, Uzzo RG et al (2015) Why summary comorbidity measures such as the Charlson comorbidity index and Elixhauser score work. Med Care 53:e65. https://doi.org/10.1097/MLR.0b013e318297429cCrossRefPubMedPubMedCentral

15.

Horasanli K, Silay MS, Altay B et al (2008) Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70 mL: a short-term prospective randomized trial. Urology 71:247–251. https://doi.org/10.1016/j.urology.2007.09.017CrossRefPubMed

16.

Chughtai BI, Simma-Chiang V, Lee R et al (2015) Trends and utilization of laser prostatectomy in ambulatory surgical procedures for the treatment of benign prostatic hyperplasia in New York State (2000–2011). J Endourol 29:700–706. https://doi.org/10.1089/end.2014.0692CrossRefPubMed

17.

Nguyen D-D, Misraï V, Bach T et al (2020) Operative time comparison of aquablation, greenlight PVP, ThuLEP, GreenLEP, and HoLEP. World J Urol 38:3227–3233CrossRefPubMed

18.

Elshal AM, Elkoushy MA, El-Nahas AR et al (2015) GreenLight^TM laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol 193:927–934CrossRefPubMed

19.

Welk B, Reid J, Ordon M et al (2019) Population-based assessment of re-treatment and healthcare utilisation after photoselective vaporisation of the prostate or electrosurgical transurethral resection of the prostate. BJU Int 124:1047–1054CrossRefPubMed

20.

Ahyai SA, Lehrich K, Kuntz RM (2007) Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial. Eur Urol 52:1456–1464CrossRefPubMed

21.

Mamoulakis C, Ubbink DT, de la Rosette JJ (2009) Bipolar versus monopolar transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol 56:798–809CrossRefPubMed

Title: Safety and efficacy of TURP vs. laser prostatectomy for the treatment of benign prostatic hyperplasia in multi-morbid and elderly individuals aged ≥ 75
Authors: David Bouhadana
David-Dan Nguyen
Xinyan Zhang
Jialin Mao
Dean S. Elterman
Alexis E. Te
Kevin C. Zorn
Naeem Bhojani
Art Sedrakyan
Bilal Chughtai
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Benign Prostatic Hypertrophy
Prostatectomy
Benign Prostatic Hypertrophy
Transurethral Prostate Resection
Prostatectomy
Laser
Published in: World Journal of Urology / Issue 12/2021
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-021-03779-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Safety and efficacy of TURP vs. laser prostatectomy for the treatment of benign prostatic hyperplasia in multi-morbid and elderly individuals aged ≥ 75

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2021

The impact of metabolic syndrome components on urinary parameters and risk of stone formation

Robotic radical prostatectomy: difficult to start, fast to improve? Influence of surgical experience in robotic and open radical prostatectomy

Robotic-assisted radical prostatectomy with the Senhance® robotic platform: single center experience

Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for renal insufficiency

Visceral Obesity in living kidney Asian donors – long term impact of renal function after donor nephrectomy

Effects of β3-adrenoceptor agonist on acute urinary retention in a rat model