Background: The aim of this study was to assess the efficacy and safety of Holmium Laser Enucleation of the Prostate (HoLEP) in the treatment of symptomatic benign prostatic hyperplasia (BPH) in elderly patients using the Trifecta Score, based on a 1-year follow-up. Methods: We conducted a retrospective analysis of patients with BPH who underwent HoLEP at our institution between January 2016 and December 2022. The patients were divided into two groups: Group 1: patients aged ≥75 years, Group 2: patients aged below 74 years. The Trifecta Score achievement rates were then evaluated. Logistic regression analyses were performed to examine the impact of age on Trifecta parameters and to assess factors associated with urinary incontinence. Results: Overall, 981 participants were enrolled, with 490 in Group 1 and 491 in Group 2. Operative characteristics were similar between groups, though Group 1 had a longer time to catheter removal. At the 3-month follow-up, Group 1 had a higher IPSS and lower Qmax compared to Group 2, while there were no significant differences in functional outcomes by one year. In terms of postoperative morbidities, Group 1 exhibited a higher rate of blood transfusion. The Trifecta Score was similar between Groups 1 and 2 (63.5% vs. 68.8%, respectively, p = 0.08), and no parameter of that score exhibited a negative correlation with age. Conclusions: HoLEP demonstrates comparable functional outcomes to those observed in younger cohorts after one year. Overall, the Trifecta Score appears to be a valuable tool for this assessment. Nevertheless, incorporating an assessment of postoperative urinary continence and 1-year postoperative Qmax could enhance the system's validity.
Journal of clinical medicine. 2025 May 13*** epublish ***
Carlo Giulioni, Matteo Tallè, Alessio Papaveri, Francesco Mengoni, Roberto Orciani, Savio Domenico Pandolfo, Ciro Imbimbo, Felice Crocetto, Valentina Maurizi, Vineet Gauhar, Angelo Cafarelli
Department of Urology, Casa di Cura Villa Igea, 60127 Ancona, Italy., Department of Urology, University of L'Aquila, 67100 L'Aquila, Italy., Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy., Internal Medicine Unit Jesi, Area Vasta 2 ASUR Marche, 60035 Jesi, Italy., Department of Urology, Ng Teng Fong General Hospital, Singapore 126817, Singapore.