Functional Outcome and Safety of Endoscopic Treatment Options for Benign Prostatic Obstruction (BPO) in Patients ≥75 Years of Age

J. Clin. Med., 2024 · DOI: 10.3390/jcm13061561 · Published: March 8, 2024

Urology Aging Research Methodology & Design

Simple Explanation

This study reviews surgical options for enlarged prostates (BPO) in men 75 years and older. It looks at how well the surgeries work and how safe they are for this age group. The study found that while older men might have slightly poorer outcomes than younger men, surgery still improves their quality of life.

Study Duration

11 years

Participants

Male patients, age ≥75 years, with the indication for surgical therapy for BPO

Evidence Level

Systematic Review and Meta-analysis

Key Findings

1
All surgical techniques significantly improve the postoperative quality of life of patients in this age group compared to their preoperative quality of life.
2
A positive linear correlation was noted between age and inferior outcome...and higher rates of overall complications and blood transfusions.
3
Complication rates for VOPs ranged from 12.97% (HoLEP) to 31.80% (PVP), with severe complications (CDS III-IV) ranging from 0.91% (PVP) to 3.52% (TURP).

Research Summary

This meta-analysis provides the summary estimates for perioperative and postoperative functional outcome and safety of endoscopic treatment options for BPO in patients ≥75 years of age. Of particular importance is that all surgical techniques significantly improve the postoperative quality of life of patients in this age group compared to their preoperative quality of life. Patients over 75 years of age experience poorer outcomes and more numerous complications such as blood transfusions after endoscopic treatment for BPO than younger patients.

Practical Implications

Surgical Safety and QoL

The patients’ priorities are surgical safety and QoL.

Individualized Treatment Plans

Currently, it is still left to the clinical judgment and intuition of the treating physician, in conjunction with the patient’s preferences and pre-existing conditions, to decide whether or not to submit a VOP to surgical therapy.

Geriatric Assessments

Tools such as geriatric assessments deserve further investigation in this setting.

Study Limitations

1
No data were available for newer interventions such as Rezum™Water Vapor Therapy or Aquablation® of the prostate that met the inclusion criteria.
2
Missing studies comparing outcomes between young patients vs. VOPs and comparing surgical techniques between VOPs.
3
The data were very heterogeneous in our meta-analysis concerning follow-up period as it ranged from 1 to 42 months.

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