Monopolar transurethral resection of the prostate in patients over 80 years of age: A retrospective, single-centre study

Abstract

Background: Bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPE) is common in elderly men, with a significant impact on quality of life. Transurethral resection of the prostate (TURP) remains the standard surgical treatment, but its safety in patients over 80 years of age is debated due to comorbidities and higher perioperative risks.

Aims and Objective: To evaluate the safety, efficacy, and functional outcomes of monopolar TURP in men aged ≥80 years.

Materials and Methods: We retrospectively reviewed records of men aged over 80 years who underwent monopolar TURP at our center between January 2022 and January 2025. Data collected included age, prostate size, presentation, comorbidities, medications, perioperative complications, and catheter-free trial outcomes. Surgical success was defined as a satisfactory patient-reported outcome, successful catheter-free trial, and post-void residual (PVR) <100 mL at 1 month.

Results: Twenty-nine patients (mean age 86.8 years) were included. Fourteen (48.3%) presented with lower urinary tract symptoms and 15 (51.7%) with acute urinary retention. The mean prostate size was 70.8 g. All patients achieved catheter-free status post-operatively, with a mean PVR of 41.2 mL. The complication rate was 6.9% (urethral stricture in one patient, meatal stenosis in one patient); all were minor and manageable. No cases of transurethral resection syndrome, blood transfusion, reoperation, or perioperative mortality occurred. One patient was incidentally diagnosed with prostate carcinoma on histopathology.

Conclusion: Monopolar TURP in men over 80 years is a safe and effective procedure with excellent functional outcomes, low morbidity, and no perioperative mortality. Careful patient selection, perioperative optimization, and meticulous surgical technique are key to achieving favorable outcomes in this high-risk group.