{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:42:25Z","timestamp":1785768145663,"version":"3.56.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Expansion of the \u201coldest-old\u201d (\u226585\u202fyears) has increased the prevalence of BPH and the need for surgery. Holmium laser enucleation of the prostate (HoLEP) is a size-independent alternative to TURP, yet age-specific outcomes remain understudied. We compared outcomes, complications, and recovery after HoLEP in men \u226585\u202fyears versus \u226455\u202fyears.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective analysis of a prospective database of HoLEP procedures performed by a single surgeon at a tertiary academic center (2017\u20132025). Men aged \u226585\u202fyears constituted the study cohort and were compared with men \u226455\u202fyears. Baseline demographics, frailty, perioperative variables, complications, and functional outcomes (IPSS, Qmax, PVR) were analyzed. Statistical comparisons used\n                      <jats:italic>t<\/jats:italic>\n                      -tests, Wilcoxon, chi-square, Fisher exact tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-one patients were included (30\u202f\u2265\u202f85; 31\u202f\u2264\u202f55). The oldest-old exhibited significantly higher comorbidities and frailty, lower baseline hemoglobin, worse renal function, and more frequent catheter dependence, while younger men had higher BMI. Operative time, hemoglobin decline, and hospital stay were comparable. Catheterization was longer in the oldest-old. The elderly had significantly more minor complications and a nonsignificant increase in major complications. UTIs occurred only in the oldest-old. Incidental prostate cancer was more common in the \u226585 cohort. Both groups showed improvements in IPSS, Qmax, and PVR; however, younger men experienced significantly greater Qmax at 12\u202fmonths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HoLEP is safe and effective in the oldest-old, offering durable improvement despite increased frailty and risk of complications. Although younger patients exhibited greater improvements in urinary flow, it is uncertain whether this finding reflects a causal benefit of earlier intervention, underscoring the need for prospective validation. Advanced age alone should not preclude HoLEP candidacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1791612","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T06:49:30Z","timestamp":1773384570000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Holmium laser enucleation of the prostate in the oldest-old: a comparative analysis across the extremes of age"],"prefix":"10.3389","volume":"13","author":[{"given":"Hasim","family":"Bakbak","sequence":"first","affiliation":[{"name":"Desai Sethi Urology Institute, University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ansh","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juanita","family":"Velasquez","sequence":"additional","affiliation":[{"name":"Desai Sethi Urology Institute, University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggie","family":"Meyreles","sequence":"additional","affiliation":[{"name":"Desai Sethi Urology Institute, University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Abdelaziz","sequence":"additional","affiliation":[{"name":"Desai Sethi Urology Institute, University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurpremjit","family":"Singh","sequence":"additional","affiliation":[{"name":"Desai Sethi Urology Institute, University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archan","family":"Khandekar","sequence":"additional","affiliation":[{"name":"Desai Sethi Urology Institute, University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E.","family":"Katz","sequence":"additional","affiliation":[{"name":"Desai Sethi Urology Institute, University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Marcovich","sequence":"additional","affiliation":[{"name":"Desai Sethi Urology Institute, University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemendra N.","family":"Shah","sequence":"additional","affiliation":[{"name":"Desai Sethi Urology Institute, University of Miami Miller School of Medicine","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"249","DOI":"10.15441\/ceem.17.261","article-title":"Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department","volume":"5","author":"Lee","year":"2018","journal-title":"Clin Exp Emerg Med"},{"key":"ref2","volume-title":"National Population by Characteristics: 2020\u20132023. Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States: April 1, 2020 to July 1, 2023","year":"2024"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/S0022-5347(17)49698-4","article-title":"The development of human benign prostatic hyperplasia with age","volume":"132","author":"Berry","year":"1984","journal-title":"J Urol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.urology.2024.10.070","article-title":"HoLEP safety and efficacy in octogenarians: a retrospective ACS-NSQIP analysis (2011\u20132020)","volume":"196","author":"Dalla","year":"2025","journal-title":"Urology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1016\/j.urology.2012.11.042","article-title":"Transurethral laser surgery for benign prostate hyperplasia in octogenarians: safety and outcomes","volume":"81","author":"Elshal","year":"2013","journal-title":"Urology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.eururo.2006.07.050","article-title":"The detrusor muscle: an innocent victim of bladder outlet obstruction","volume":"51","author":"Mirone","year":"2007","journal-title":"Eur Urol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.eururo.2023.04.008","article-title":"Management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. 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Summary paper of the 2023 EAU guidelines","volume":"84","author":"Gravas","year":"2023","journal-title":"Eur Urol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1097\/JU.0000000000002184","article-title":"Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part II \u2013 surgical evaluation and treatment","volume":"206","author":"Lerner","year":"2021","journal-title":"J Urol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1007\/s00345-024-05285-7","article-title":"Perioperative outcomes and trends of transurethral surgeries for benign prostatic hyperplasia in octogenarians: a comprehensive analysis using the NSQIP database (2011\u20132022)","volume":"42","author":"Abdelaziz","year":"2024","journal-title":"World J Urol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/s00345-010-0561-3","article-title":"Impact of oral anticoagulation on morbidity of 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