(212) Minimally Invasive Surgical Therapies for Benign Prostatic Hyperplasia in the Geriatric Population: A Systematic Review
Authors: Abid A , Babar M , Piperdi H , Loloi J , Zhu M , Azhar U , Maria P , Small A 
Published: February 2024

Abstract

Introduction
Benign prostatic hyperplasia (BPH) is an extremely common disease in aging men and can lead to lower urinary tract symptoms (LUTS) and complications. While the initial management of BPH includes behavioral modifications and pharmacologic therapies, older patients have increased susceptibility to adverse events (AEs) and therefore have decreased compliance. Consequently, geriatric patients may benefit from minimally invasive surgical therapies (MISTs) as treatment alternatives for BPH. Currently, there is no systematic review describing MISTs outcomes in specifically older populations.

Objective
To evaluate the efficacy and safety profile of MISTs in geriatric patients with BPH.

Methods
PubMed/MEDLINE database was systematically searched for relevant articles in the English language through June 24, 2023. Studies that evaluated surgical and/or urinary outcomes of MISTs in geriatric patients (≥65 years of age) were deemed eligible. Studies were included if there was separate reporting for age subgroups ≥65 years, if mean age minus SD was ≥65 years, or if median age minus Q1 was ≥65 years. Studies with patients with catheter dependent urinary retention were not excluded.

Results
A total of 263 studies were screened, of which 22 (N=2,911 patients) met inclusion. Of the 22 studies, 3 evaluated PAE, 1 evaluated Rezum, 7 evaluated GreenLight, 4 evaluated HoLEP, 4 evaluated ThuLEP, 1 evaluated DiLEP, 1 evaluated Aquablation, and 1 evaluated both PAE + Rezum. The Rezum study and the PAE + Rezum study only included patients with an indwelling catheter at baseline. Follow-up ranged between 1 and 36 months (median 12 months). All the MISTs were performed inpatient and required hospitalization. Hospitalization times ranged between 0.9 and 7.6 days (median 3 days) and was the longest for DiLEP (median 7.6 days) and PAE (median 5.1 days) and the shortest for Rezum (median 1 day). Procedure time ranged between 4.8 and 148 minutes (median 70.6 minutes), with PAE having the longest time (median 102 minutes) and Rezum having the shortest time (median 6.4 minutes). When compared to baseline, PAE, GreenLight, HoLEP, ThuLEP, DiLEP, and Aquablation showed significant percent changes in international prostate symptom score (median -69.6%), quality of life (-72.7%), maximum urinary flow (113.1%), and postvoid residual (-80.1%) at a median of 12 months postoperatively. The studies assessing catheter independence in patients with chronic urinary retention reported a catheter-free rate of 100% for Rezum and 45.5% for PAE at 12 months postoperatively. Occurrence of AEs ranged between 0 and 67.5% (median 12.2%). AEs were lowest for HoLEP (median 4.6%) and Rezum (median 8.8%) and highest for PAE (33.1%) and Aquablation (34%). Reoperation rates across all MISTs ranged between 0 and 5% (median 1.5%) at a median of 12 months postoperatively.

Conclusions
Although all the MISTs reviewed in this study resulted in durable improvements in LUTS secondary to BPH in the geriatric population, differences in procedural characteristics and safety profiles across MISTs were considerable. Rezum had the shortest procedure and hospitalization time and lowest occurrence of AEs, while PAE had the longest procedure and hospitalization time and highest occurrence of AEs. Additional studies evaluating Rezum in elderly patients without urinary retention are warranted.

Disclosure
No.