Endoscopic enucleation of the prostate in men aged 80 years and older. Outcomes from a global, large, and multicenter series using different energy sources and techniques.

Objective: To provide the outcomes from a multicentric series of men aged 80 years and above, understand the feasibility of endoscopic enucleation of the prostate (EEP), and compare different energy sources and techniques.

Methods: We extracted data on patients who underwent EEP in 15 Centers (January 2019-January 2023). Continuous variables are expressed as medians and interquartile ranges while categorical variables as absolute numbers and percentages. A multivariable logistic regression analysis was performed to identify predictors of overall postoperative incontinence and reported as odds ratio (OR) and 95% confidence interval (CI).

Results: 731 patients were included. Median age was 82 years and median prostate volume (PV) was 90 cc. 33.1% of participants had PV ≤ 80 ml, 28.4%. between 81 and 100 ml, 36.7% between 101 and 200 ml, and 1.8% of more than 200 ml. Median International Prostate Symptom Score was 23 [20-26]. EEP was mainly performed with the en-bloc technique (367 cases, 50.3% of the total). Total median operation time was 80 min [60-110]. Postoperative urinary incontinence was reported in 113 patients (15.5%). Complication rate was low with only 16 patients (2.2%) suffering from major complications (sepsis: 1 case; bleeding requiring surgical control: 13 cases; secondary morcellation: 2 cases). At multi-variable analysis, PV > 200 ml was significantly associated with higher odds of incontinence (OR 5.84 95% CI 1.76-18.96), whilst en-bloc enucleation with lower odds (OR 0.51 95% CI 0.32-0.80).

Conclusions: EEP in men aged 80 years and above is a safe, efficacious, and size-independent procedure. In glands larger than 200 ml there may be a prolonged period of incontinence, mainly stress-related. En-bloc enucleation may be a better approach to minimize early urinary incontinence.