Introduction We aimed to evaluate the superiority of different comorbidity indices in determining the most suitable elderly male candidates for uro-oncological operations. While making this assessment, we also aimed to determine the risk factors that may affect surgery-related major complications and overall survival. Material and methods Data of 543 male patients, 60 years or older, who underwent uro-oncological surgery (radical cystectomy, radical prostatectomy, radical or partial nephrectomy, transurethral resection of bladder tumor) between September 2009 and January 2019 were retrospectively evaluated. Demographic, clinical and pathological characteristics of the patients, preoperative comorbidity indices, postoperative complications, length of hospitalization, re-admission rates within 90 days and postoperative follow-up outcomes were recorded. Patients in similar tumor stages were divided into different subgroups. All subgroups were divided into two main categories: middle age (60–69 years-old) and elderly age (≥70-years-old). Results No significant difference was found for all types of surgery in terms of postoperative outcomes in both age groups (p >0.05). Age-adjusted Charlson Comorbidity Index (ACCI), Preoperative Score to Predict Postoperative Mortality (POSPOM), Rockwood Frailty Index (RFI) and tumor characteristics were found to be more significant predictors for postoperative major complications and overall mortality than Eastern Cooperative Oncology Group (ECOG), American Society of Anesthesiologists (ASA) and New York Heart Association (NYHA) functional classification. Conclusions Our findings show that patient age alone is not a risk factor for increased postoperative complications and overall mortality. Although many different comorbidity indices have been used in urological practice, ACCI, POSPOM and RFI are more valuable predictors. Uro-oncological surgeries may be performed safely in elderly males after a good clinical decision based on these indices.

BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.