Dora, C

Abstract Introduction Holmium laser enucleation of the prostate (HoLEP) is a safe, effective and durable surgical treatment for benign prostatic hyperplasia (BPH). With increased longevity, there is expanded interest in assessing the safety and efficacy of HoLEP in patients aged 90 years and older. Additionally, these patients are particularly interested in HoLEP when dealing with chronic retention secondary to BPH. Objective To evaluate the safety and functional outcomes of HoLEP in nonagenarian patients. Methods We conducted a retrospective review of patients aged 90 years or older who underwent HoLEP by a single surgeon at our institution from January 2019 to May 2024. Data collected included preoperative prostate volume, postoperative length of hospital stay, complication rates, postoperative American Urological Association Symptom Score (AUASS), quality of life (QOL) scores, and catheter status. Results Eighteen patients met inclusion criteria, with a mean preoperative prostate volume of 106 grams. Fourteen patients were on anticoagulation therapy but all were able to stop their medications at least 2-3 days prior to surgery. Six postoperative complications occurred, including three major events: aspiration, congestive heart failure exacerbation, and one death during admission. At last follow-up, four patients had passed away due to unrelated events, with only one death occurring during the HoLEP hospitalization. Among surviving patients, the mean AUASS was 7 and mean Michigan Incontinence score was 0.9. Preoperatively, 15 patients were catheter-dependent; postoperatively, only one patient required catheter reinsertion after trial of void. Discharge occurred on postoperative day (POD) 0 for six, POD 1 for four, POD 2 for three, and POD 3 for four patients. Conclusions HoLEP is a feasible and effective surgical option for patients aged 90 years and older, providing significant improvement in urinary symptoms, low rates of reported incontinence, and high rates of catheter independence. Nonagenarians anecdotally seem more likely to experience complications, highlighting the importance of careful patient selection/counseling and perioperative management. The 30-day mortality was ultimately due to the patient’s family’s desire to withdraw care and proceed with hospice. Although it’s difficult to objectively evaluate, we believe that overall, these patients do stand to benefit from HoLEP as their catheter-dependency often leads to recurrent infections, admissions, decreased mobility and falls. These medical issues can also lead to poor outcomes in this age group. Disclosure No