Can a Simple Geriatric Assessment Predict the Outcome of TURP?

Eredics, Klaus; Meyer, Christine; Gschliesser, Tanja; Lodeta, Branimir; Heißler, Ortwin; Kunit, Thomas; Madersbacher, Stephan

doi:10.1159/000506717

Cited by 15 publications

(14 citation statements)

References 16 publications

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“…The indication for disobstructive surgery in elderly patients has to balance life expectancy, functional outcome and surgical risk [2]. Approximately, 12% of patients older than 75 years of age die within 12 months after the first episode of urinary retention and this rate increases up to 30% in nursing home patients who underwent TURP [2][3][4]. In parallel, the functional outcome decreases with advancing age with age-related detrusor underactivity being a relevant co-factor [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Transurethral resection of the prostate in 85+ patients: a retrospective, multicentre study

Lotterstätter¹,

Seklehner

Wimpissinger

et al. 2022

World J Urol

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Purpose To determine the safety and efficacy of transurethral resection of the prostate (TUR-P) in patients 85 years or older. Methods In this retrospective, multicentre study, patients equal or older than 85 years at the time of surgery (2015–2020) were included. Several pre-, peri- and postoperative parameters were collected. The main outcome criterion was spontaneous voiding with a post-void residual (PVR) volume < 100 ml at dismission and at 12 months after surgery. Results One hundred sixty-eight patients (median age: 87 years, interquartile range [IQR]: 86–89) were recruited. The patients took on average 5.2 permanent medications (3–8), 107 (64%) were anticoagulated preoperatively and neurological co-morbidities were present in 29 (17%). The indication for surgery was recurrent urinary retention in 66.3% (n = 110) with a mean retention volume of 849 ml. The mean PVR volume of the remaining 35% was 146 ml. Surgery was successfully completed in all patients. A perioperative surgical revision had to be performed in 3% and 13 patients (7.7%) required blood transfusion. After catheter removal, 85% of patients were able to void spontaneously with a PVR < 100 ml, and 14.3% were dismissed with a catheter. Twelve months data were available for 93 patients (55%). Of this cohort, 78 (83.9%) were able to void spontaneously with a PVR < 100 ml, 12 (12.9%) were on permanent catheterization. One patient (0.6%) died perioperatively. The only significant factor associated with an unsuccessful outcome was the number of permanent medications (6.8 vs. 5.0, p = 0.005). Conclusion This retrospective multicentre study documents the safety and efficacy of TURP (monopolar and bipolar) in the old-old cohort.

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Section: Introductionmentioning

confidence: 99%

Transurethral resection of the prostate in 85+ patients: a retrospective, multicentre study

Lotterstätter¹,

Seklehner

Wimpissinger

et al. 2022

World J Urol

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“…However, success rate of surgery was 80.6% in fit and 75% in frail patients, while 3-month success rates were 95.2% and 83.3% for non-rail and frail respectively (24). Post-Void Residual (PVR) was less than 50 ml in both cohorts (24). Pichon et al, showed that frail patients had lower success rate at 3 months (55%) compared to non-frail patients (95%) (p < 0.05) following TURP (25).…”

Section: Resultsmentioning

confidence: 86%

“…According to Soma et al frailty was positively associated with LUTS (HR: 2.13; 95%; CI: 2.48-3.06), OAB (HR: 2.07; 95%; CI: 1.31-3.29) and higher prevalence of nocturia (23). According to Eredics et al, intraoperative complications, duration of postoperative catheterization and length of hospitalization was identical in frail and non-frail patients undergoing transurethral resection of the prostate (TURP) (24). However, success rate of surgery was 80.6% in fit and 75% in frail patients, while 3-month success rates were 95.2% and 83.3% for non-rail and frail respectively (24).…”

Section: Resultsmentioning

confidence: 99%

“…According to Eredics et al, intraoperative complications, duration of postoperative catheterization and length of hospitalization was identical in frail and non-frail patients undergoing transurethral resection of the prostate (TURP) (24). However, success rate of surgery was 80.6% in fit and 75% in frail patients, while 3-month success rates were 95.2% and 83.3% for non-rail and frail respectively (24). Post-Void Residual (PVR) was less than 50 ml in both cohorts (24).…”

Section: Resultsmentioning

confidence: 99%

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Frailty and benign prostatic hyperplasia: The thrilling underlying impact

Bellos

Tzelves

Manolitsis

et al. 2022

Arch Ital Urol Androl

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Background: World population is aging. The number of individuals aged over 65 are expected to be 71 million only in the US. 43% of this population will be men. Benign prostatic hyperplasia (BPH), defined as the benign neoplasm of the prostate gland affects 8% of men by their forties, but 90% of men over 90 years old. Lower urinary tract symptoms (LUTS) can be caused by an enlarged prostate, and it seems to be associated more with older and frailer individuals. Methods: The purpose of this study is to review the potential interplay between frailty syndrome and benign prostatic hyperplasia. A thorough MEDLINE/PubMed non-systematic literature review was conducted from 1990 to March of 2022. The terms used for the search were “frailty and benign prostatic hyperplasia” and “low muscle mass and benign prostatic hyperplasia”. Results: It seems that, frailty poses a negative impact on the prognosis of patients with BPH, as it is associated with increased incidence of LUTS. In addition, frailty seems to be a strong predictor concerning surgical procedure failure and mortality following invasive procedures for BPH. Prostatic stent placement on the other hand appears to be the ideal solution for frail patients. Conclusions: BPH has a strong association with frailty and increasing age.

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“…We therefore aimed to prospectively evaluate validated geriatric assessment tools as predictors of functional outcomes, peri- and postoperative complications, and mortality in patients undergoing radical urological tumor surgery at the age of 70 years or older. Inspired by very simple assessments for the prediction of functional outcome in other urological surgeries [16], we created the Erlangen Index (EI), which is highly feasible and predictive for functional deterioration and mortality in major urological tumor surgery.…”

Section: Introductionmentioning

confidence: 99%

Geriatric Assessments Can Predict Functional Outcome and Mortality after Urological Tumor Surgery

Kahlmeyer¹,

Fiebig²,

Mueller³

et al. 2021

Urol Int

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Introduction: Older patients undergoing major urological tumor surgery are at severe risk of functional deterioration, complications, and mortality. We prospectively evaluated geriatric assessment tools and developed a novel easy-to-use assessment tool for clinical use. Methods: In 159 patients, geriatric assessment tools were used prior to cystectomy, prostatectomy, and renal tumor surgery, and their peri- and postoperative courses were recorded. Using all the tests, a short and easy-to-use assessment tool was developed, and nomograms were generated to predict functional outcomes and mortality. Results: Of all the patients, 13.8% underwent radical cystectomy, 37.7% underwent radical prostatectomy, and 48.4% underwent tumor surgery of the kidney at the age of 70 years or older. The average age was 75.6 years. Incomplete functional recovery at day 30 and day 180 was observed in 37.7% and 36.1% of the patients, respectively, and incomplete functional recovery was associated with impaired mobility, previous care dependency, frailty, comorbidities, and a high ASA score. The only predictor for high-grade complications was comorbidities, whereas mortality was associated with the geriatric screening tool scores, impaired mobility, preoperative care dependency, and comorbidities. The Erlangen Index (EI), a combination of the selected assessment tools, showed a good prediction of early (p = 0.002) and medium-term (p = 0.002) functional outcomes and mortality (p = 0.001). Conclusion: Our prospective evaluation confirms the high risk of incomplete functional recovery, high-grade complications, and mortality in older patients undergoing major urological tumor surgery. The EI is an easy-to-use preoperative assessment tool and therefore should be used in preoperative patient counseling.

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Can a Simple Geriatric Assessment Predict the Outcome of TURP?

Cited by 15 publications

References 16 publications

Transurethral resection of the prostate in 85+ patients: a retrospective, multicentre study

Transurethral resection of the prostate in 85+ patients: a retrospective, multicentre study

Frailty and benign prostatic hyperplasia: The thrilling underlying impact

Geriatric Assessments Can Predict Functional Outcome and Mortality after Urological Tumor Surgery

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