Safety and Efficacy of Laser Enucleation of the Prostate in Elderly Patients - A Narrative Review.

Benign prostatic hyperplasia (BPH) is a common health condition in aging men resulting in lower urinary tract symptoms (LUTS) and low quality of life (QoL). We aimed to review studies on laser enucleation of the prostate (LEP) due to LUTS in elderly patients (>65 years) comparing different age groups, particularly considering functional outcomes, safety, and perioperative complications. A comprehensive search was conducted using the PubMed-MEDLINE, Web of Science, Wiley Online Library and Cochrane Library databases over the last 10 years until 7 October 2021 with the following search terms solely or in combination: "laser enucleation", "prostate", "laser prostatectomy", "aging", "elderly patients", "older patients" and "age". We identified 12 articles for inclusion in our analysis. Five studies focussed mainly on holmium laser enucleation of the prostate (HoLEP), one compared HoLEP to other laser prostatectomy procedures, two studies examined thulium laser enucleation of the prostate (ThuLEP), and two studies focused on GreenLight laser, one study focussed on potassium-titanyl-phosphate (KTP) laser, and another study compared laser prostatectomy to transurethral resection of the prostate (TURP). These studies showed that LEP improved IPSS, Qmax and QoL compared to baseline regardless of age; no significant difference was reported among age groups. Although ASA scores and anticoagulation/antiplatelet therapy rates are higher in elderly patients, studies revealed no significant difference in perioperative complication rates between age groups. Laser enucleation of the prostate is an effective and safe procedure in elderly patients, resulting in good functional outcomes, low morbidity, and few perioperative complications.

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© 2022 Yilmaz et al.

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Prof. Dr. Christian Gratzke is advisor for Astellas Pharma GmbH, DE, Ipsen Pharma GmbH, DE, Steba Biotech S.A., LUX, Bayer Pharma, DE, Olympus Winter & Ibe GmbH, DE, Medi-Tate Ltd., IL, MSD, DE, Astra-Zeneca, UK and Roche, CH. He receives speaker fees from Amgen, USA, Astellas Pharma GmbH, DE, Ipsen Pharma GmbH, DE, Janssen-Cilag GmbH, BEL, Bayer Pharma, DE, Takeda Pharmaceuticals, JPN and medac GmbH, DE. A. Miernik receives research funding from the German Federal Ministry of Education and Research, Berlin (D). He receives support for his travel activities from the European Society of Urology, Arnhem (NL), and German Society of Urology, Düsseldorf (D). A. Miernik is also a consultant for: KLS Martin, Tuttlingen (D), Avateramedical, Jena (D), LISA LaserProducts GmbH, Katlenburg-Lindau (D), Schoelly fiber optics GmbH, Denzlingen (D), Dornier MedTech Laser GmbH (D), Medi-Tate Ltd. (IL, USA) and B. Braun New Ventures GmbH, Freiburg (D). A. Miernik is speaker for the companies Richard Wolf GmbH (D) and Boston Scientific (USA). He also served as a reviewer for the Ludwig Boltzmann Gesellschaft, Wien (A). In addition, Prof. Dr. Arkadiusz Miernik has a patent WO2014173468A1 licensed to Purenum GmbH, German start-up, a patent EP2988681A1 licensed to Purenum GmbH, German start-up, a patent WO2015082372A1 pending; a patent WO2017207361A1 pending; a patent DE102019220537A1 pending; a patent DE102019134352A1 pending; a patent DE102015003560B3 issued; a patent WO2021005060A1 pending. M. Yilmaz, J. Esser and Rodrigo Suarez have no conflicts of interest to declare.