Holmium Laser Enucleation of the Prostate in Octogenarians: 16-year Experience in a High-volume Center

The increasing prevalence of benign prostatic hyperplasia leads to an ever growing number of surgeries in elderly patients, despite limited data on perioperative outcomes. The objective of this study was to analyze perioperative outcomes in patients older than 80 yr undergoing holmium laser enucleation of the prostate (HoLEP).

A retrospective analysis of 12 346 cases of HoLEP from 2008 to 2024 was conducted, identifying 1821 octogenarians. Propensity score matching was performed based on the following parameters: intake of anticoagulants, presence of a urinary catheter on the day of surgery, and prostate size. Perioperative outcomes and postoperative complications of a total of 1519 matched datasets were analyzed.

In the unmatched population, patients older than 80 yr had larger prostates, took anticoagulants more often, and were more likely to have a urinary catheter at admission compared with younger patients (p < 0.001). After matching, these variables were well adjusted in both groups. Operating and catheterization times did not differ between both groups. The risk of a failed first voiding trial was significantly higher in octogenarians (12% vs 6.6%; p < 0.001) and led to a higher catheterization rate at discharge in the octogenarian group. No statistical difference was seen in other postoperative complications. Limitations are the retrospective study design and concomitant selection bias.

Our data indicate that HoLEP is safe in patients older than 80 yr and perioperative outcomes are generally comparable with those of younger patients. Octogenarians had a significantly higher incidence of a failed first voiding trial, which should be considered in postoperative management.