[Urological surgery in the octogenarian: excessive preconceptions?]

We reviewed the records of 277 patients aged 80 or older that had been considered for surgery during the period 1980-1990. We analyzed the surgical risk (Goldman and ASA score), patient history, type of surgery and the post-operative course (Karnofsky index) in order to identify the risk factors and to permit objective and practical selection of patients amenable to surgical treatment. Overall, regardless of sex, the benign (35%) and malignant (18%) diseases of the prostate and bladder neoplasms (30%) accounted for more than 80% of the surgical procedures. The early postoperative complications were shown to be influenced by the type of surgery (emergency surgery), the approach (open surgery), the presence of preoperative urinary tract infections and the ASA score. Regardless of the cure rate, the analysis of the postoperative course and data gleaned from telephone interviews indicate that 61.5% of the patients probably had a very good or good quality of life at 6 months. In the non-operated group 1 out of 10 procedures that had been anticipated was not performed and many had a malignant disease. Although there were more patients with fair/poor quality of life in the patient group that did not undergo surgery than in the operated group (42.8% versus 28.5%, respectively), patient general condition at 6 months was very good or good in 50% of the patients that were followed or interviewed. The use of the preoperative evaluation methods and our clinical experience can eliminate subjective evaluation and permit developing safe and precise surgical programs.