Safety and clinical outcomes of GreenLight laser prostatectomy in octogenarians.

INTRODUCTION: We evaluated the impact of age on perioperative morbidity and clinical outcomes in patients undergoing GreenLight laser prostatectomy for benign prostatic hyperplasia (BPH). METHODS: We conducted a retrospective study of prospectively collected data from individuals who underwent GreenLight laser prostatectomy from May 2018 to July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure and American Society of Anesthesiology (ASA) scores. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS ), quality of life (QoL) assessment, maximum urinary flow rate (Qmax), postvoid residual volume (PVR), and catheter-free status. RESULTS: One-hundred-sixty-eight males who underwent GreenLight laser prostatectomy were included. The non-octogenarian group consisted of 111 patients and the octogenarian group comprised 57 individuals. Based on ASA scores, most octogenarians were deemed high-risk (ASA III: 91.2%), while over half of non-octogenarians were lower-risk (ASA II: 53.2%) (p<0.001). Intraoperative parameters, including operative time, vaporization time, lasing time, and energy did not differ significantly between groups. There was no difference in the proportion of intraoperative complications between non-octogenarians and octogenarians (0.9% vs. 3.5%). Postoperative complications were not statistically significant between the two groups (p=0.608). There was also no observed difference in the proportion of patients requiring readmission (p=0.226) or retreatment (p=1.0). CONCLUSIONS: GreenLight laser prostatectomy is a safe and effective treatment for BPH regardless of age. It provides similar surgical and functional outcomes as younger men while maintaining the QoL of octogenarians.

History of infantile BCG immunization did not predict lamina propria invasion and/or high-grade in patients with non-muscle invasive bladder cancer.

OBJECTIVE: To evaluate the utility of infantile BCG vaccination history in predicting stage and grade of tumours in non-muscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS: We retrospectively analyzed data from patients from a single center who were diagnosed with new NMIBC and underwent transurethral resection of bladder tumour (TURBT) between 2017 and 2022. We assessed BCG immunization status with various demographics and comorbidities, as well as tumour recurrence, progression, stage, and grade. RESULTS: A total of 188 patients met the inclusion criteria for our study. The mean age of patients at the time of diagnosis was significantly lower in those that had been immunized with BCG (71 ± 9) than those who had not (77 ± 10) (p < 0.0001). History of BCG immunization did not correlate with sex, history of diabetes mellitus (DM), prior history of intravesical BCG treatment, and tumour recurrence, progression, stage, and grade. CONCLUSIONS: History of infantile BCG vaccination did not correlate with the depth of invasion and/or the grade in patients with non-muscle invasive bladder cancer. Patients that received infantile BCG vaccination were significantly younger at the time of diagnosis of NMIBC.

Diagnostic assessment program for prostate cancer: Lessons learned after 2 years and degree of compliance to Canadian guidelines.

BACKGROUND: In 2018, our Institute launched the Diagnostic Assessment Program (DAP) for prostate cancer. It enabled quick access to a urologist for patients presented to family physician with elevated PSA and allowed fast multidisciplinary patient care. We aim to document our data over 2 years in comparison to data before implementation of DAP and its impact on the degree of adherence to Canadian guidelines. METHODS: From April 2016 to April 2020, 880 patients who were evaluated for prostate cancer at Thunder Bay Regional Health Sciences Centre (TBRHSC) were included in this study. Patients' characteristics, clinical data, waiting times and line of treatment before and after implementation of DAP were calculated and statistically analysed. RESULTS: The median waiting time to urology consultation was significantly reduced from 68 (IQR 27-168) days to 34 (23-44) days (p < 0.001). The time from patient's referral to prostate biopsy decreased substantially from 34 (20-66) days to 18(11- 25) days after DAP (p < 0.001). After DAP, the percentage of Gleason 6 detected prostate cancers were significantly increased (19.7% to 30%) (p = 0.02). After DAP, rate for intermediate-risk patients elected for external beam radiotherapy (from 53.5% to 57.9%, p = 0.53) and radical prostatectomy (from 34.5% to 39.4%, p = 0.47) increased. More compliance to Canadian guidelines was observed in intermediate risk patients (88% vs 97.3%, p =.008). CONCLUSIONS: Implementation of DAP has led to a notable reduction of waiting time to urology consult and prostate biopsy. There is significant increase in Gleason 6 detected prostate cancer. Increased compliance to Canadian guidelines was detected in intermediate risk patients.