Application of transurethral blue laser vaporization of the prostate in Patients Aged 80 and Above: A Single-Center Clinical Analysis of 157 Cases

Application of transurethral blue laser vaporization of the prostate in Patients Aged 80 and Above: A Single-Center Clinical Analysis of 157 Cases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application of transurethral blue laser vaporization of the prostate in Patients Aged 80 and Above: A Single-Center Clinical Analysis of 157 Cases Chao Wang, Xiaoliang Fu, Yayun Ji, Haifeng Cheng, Guoxiong Liu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7533815/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Dec, 2025 Read the published version in Lasers in Medical Science → Version 1 posted 12 You are reading this latest preprint version Abstract Purpose: This study aims to assess the safety and effectiveness of transurethral blue laser prostate vaporization (BVP) for elderly patients (≥80 years) with benign prostatic hyperplasia (BPH), focusing on clinical outcomes, recovery, and complications. Methods: A retrospective analysis was performed on 157 BPH patients aged ≥80 years who underwent BVP at a single center between May 2023 and May 2025. Data on demographics, prostate volume, comorbidities, procedure details, and postoperative outcomes were collected. Results: The mean age was 83.97±3.63 years, with an average prostate volume of 63.34±34.95 ml. Patients had an average of 2.5 comorbidities, and 26.1% required additional surgical interventions. The average procedure time was 28.2±12.1 minutes, with a median hospital stay of 9 days. Postoperative IPSS scores decreased significantly to 4.3±3.5. Mild red blood cell loss (hemoglobin decreased by 6.1%, p<0.001) and a significant inflammatory response (neutrophils increased by 26.5%, p<0.001) were observed, but no transfusion was needed. Conclusion: Transurethral blue laser prostate vaporization is a safe and effective option for elderly BPH patients with multiple comorbidities, offering significant symptom improvement with minimal postoperative complications. blue laser vaporization benign prostatic hyperplasia advanced age clinical Analysis Figures Figure 1 Figure 2 Introduction Benign prostatic hyperplasia (BPH) is a common urological condition affecting the health of elderly men, with its incidence significantly increasing with age [1, 2] . Particularly in patients aged 80 years and older, BPH is often accompanied by more severe lower urinary tract symptoms (LUTS) and a higher risk of comorbidities, which makes the selection of appropriate treatment strategies more challenging [3-5] . Traditional treatments, such as pharmacotherapy, may be limited in elderly patients due to drug side effects and adherence issues [6, 7] . Furthermore, conventional surgical methods, such as transurethral resection of the prostate (TURP), may not be suitable for some elderly, frail patients due to their high invasiveness, longer recovery time, and increased risk of complications [8] . Therefore, seeking safe, effective, and minimally invasive treatment options for elderly BPH patients has become an important clinical need. In recent years, laser technology has been widely applied in the treatment of BPH [9-11] . Compared to traditional TURP, laser treatments offer advantages such as reduced bleeding, shorter procedure times, and shorter hospital stays, making them theoretically more suitable for elderly patients with multiple comorbidities [12] . Among these laser treatments, transurethral blue laser vaporization of the prostate (BVP) has emerged as a promising minimally invasive approach, demonstrating potential in elderly BPH patients due to its unique benefits [13] . Blue laser uses a specific wavelength of laser energy to precisely vaporize hyperplastic prostate tissue, thereby relieving urinary obstruction and improving LUTS. However, the physiological characteristics of elderly patients present challenges for blue laser treatment. Elderly patients often have multiple comorbidities, such as cardiovascular and respiratory diseases, which increase the surgical risks and the complexity of perioperative management [14] . Therefore, performing blue laser vaporization on elderly BPH patients requires a thorough assessment of their overall health, the development of individualized treatment plans, and enhanced perioperative management to ensure the safety and efficacy of the procedure. Several studies have evaluated the application of laser treatments in elderly BPH patients [15] . However, due to limitations in sample size, study design, and other factors, especially regarding blue laser, further evidence is needed. This study aims to retrospectively analyze the clinical data of 157 BPH patients aged ≥80 years who underwent blue laser vaporization at a single center. By evaluating key indicators such as surgical outcomes, postoperative recovery, and complication rates, this study seeks to provide more comprehensive evidence for optimizing treatment strategies for elderly BPH patients. Materials and Methods 1. Study Subjects Between January 2023 and January 2025, 157 patients aged ≥ 80 years with benign prostatic hyperplasia (BPH) were consecutively enrolled at a single center. Inclusion criteria were as follows: patients with a prostate-specific antigen (total PSA) level of 0–4 ng/ml and a free-to-total PSA ratio greater than 0.16. Patients with abnormal PSA levels were required to undergo prostate MRI 3.0 + DWI, and those with a PI-RADS score of 1–2 were included [ 16 , 17 ] . For patients with a PI-RADS score of 3–5 on prostate MRI 3.0 + DWI, prostate biopsy was required to confirm a benign diagnosis. Patients meeting these criteria were included in the study, while others were excluded. All patients included in the study had pathological samples taken intraoperatively for further screening for prostate cancer. More exclusion criteria included: patients with urine analysis and sediment examination showing bacterial counts exceeding 385/ml, or those with clear urinary tract irritative symptoms that could not be relieved after treatment; patients with a urinary flow dynamics test BOOL value less than 40 [ 18 ] ; and patients with severe dementia, paralysis, hemiplegia, or other similar conditions. 2. Surgical Methods A total of 116 patients (73.9%) underwent single BVP, using a 450nm blue laser system. During the procedure, the blue laser power was set to 200W, with the system's built-in red light used for hemostasis, set at 50W. Blue laser was applied at five points around the bladder neck to vaporize and remove the hypertrophied prostate tissue, while ensuring protection of the external urethral sphincter and seminal vesicles to avoid injury. After the resection, the patency of the urethral orifice was confirmed, with no significant obstruction observed (Fig. 1 ). A three-way catheter was placed postoperatively, and bladder irrigation was performed for 12 hours. The catheter was removed on the third postoperative day. Twenty-one patients (13.4%) presented with abnormal bladder compliance and reduced detrusor pressure, and were treated with BVP combined with a bladder stoma catheter insertion. On the 14th postoperative day, the stoma catheter was clamped, and patients were encouraged to attempt spontaneous urination. If the residual urine volume was less than 50ml on each attempt and persisted for one week, the stoma catheter was removed. Fifteen patients (9.6%) developed bladder stones and underwent BVP combined with transurethral bladder pneumatic ballistic lithotripsy. Two patients (1.3%) had both abnormal bladder compliance, reduced detrusor pressure, and bladder stones, and were treated with BVP combined with transurethral bladder pneumatic ballistic lithotripsy and bladder stoma catheter insertion. One patient (0.6%) had a bladder tumor and underwent BVP combined with transurethral bladder lesion resection. One patient (0.6%) presented with abnormal bladder compliance, reduced detrusor pressure, and a bladder tumor, and received BVP, bladder stoma catheter insertion, and transurethral bladder lesion electroresection. One patient (0.6%) had abnormal bladder compliance, reduced detrusor pressure, and unilateral testicular purulent epididymitis, and underwent BVP, bladder stone removal, and unilateral orchiectomy. 3.Observational Indicators The following parameters were recorded: patient age, the three-dimensional measurements of the prostate’s three diameters and volume (measured using 3D ultrasound), preoperative comorbidities, surgical duration (only the time spent on the BVP procedure), length of hospital stay, postoperative International Prostate Symptom Score (IPSS), complications, and dynamic changes in blood routine tests on the day before and one day after the surgery. 4.Statistical Analysis Data were analyzed using SPSS 26.0 software. Continuous variables are presented as mean ± standard deviation (SD). Paired t-tests were used for group comparisons. A p-value of less than 0.05 was considered statistically significant. Results 1.Baseline Characteristics: The average age of the patients was 83.97 ± 3.63 years (range 80–98 years), with 7.6% (12 cases) being over 90 years old. The prostate-related characteristics of the patients were as follows: left-right diameter 5.36 ± 0.81 cm, superior-inferior diameter 4.68 ± 1.15 cm, anterior-posterior diameter 4.45 ± 0.85 cm, volume 63.4 ± 34.9 ml (range 8.7–178.1 ml), with a median of 57.6 ml. Among the patients, 25.7% had severe benign prostatic hyperplasia (BPH) with a prostate volume > 80 ml. More than half of the patients experienced urinary retention, and nearly half had urinary tract infections, which may be closely related to urinary retention. These infections were resolved following anti-infection treatment. One-third of the patients had abnormal PSA levels, but prostate cancer was ruled out through prostate MRI and prostate biopsy. A high proportion of patients had comorbid systemic diseases, including hypoproteinemia (19.1%), mild anemia (15.3%), diabetes (11.5%), chronic bronchitis or emphysema (19.1%), coronary heart disease (15.3%), and heart failure (2.5%) (Fig. 2 ). Additionally, 5.2% of the patients had abnormal electrocardiogram findings (Table 1 ). Table 1 Main Types and Proportions of Electrocardiographic Abnormalities. Category Proportion TypicalManifestations Conduction System Abnormalities 34.5% Bundle branch block, prolonged PR interval Myocardial Ischemia Signs 27.6% ST-T changes, pathological Q waves Arrhythmias 29.3% Atrial fibrillation, premature ventricular contractions, sinus arrest Cardiomyopathy Signs 8.6% Left ventricular hypertrophy, features of cardiomyopathy 2.Surgery and Hospitalization The primary surgical method used was BVP, with 26% of cases requiring additional procedures (such as bladder diversion in 13.4% and bladder stone extraction in 8.3%). Five cases involved a combination of three surgical procedures (specific methods are detailed in the relevant section). The average surgical duration was 28.2 ± 12.1 minutes (range 8–69 minutes), with 75% of cases completed within 33 minutes, and 83.3% of cases falling within the 15–40-minute range. For patients with a prostate volume between 45 and 95 ml, the surgical time ranged from 21 to 51 minutes. The median hospitalization duration was 9 days (range 4–25 days), with 75% of patients staying for 9 days or fewer. The distribution of hospitalization duration was right-skewed, with a peak at 8.5 days. 3.Postoperative Recovery On the first postoperative day, there was mild erythrocyte depletion, with a synchronized decrease in hemoglobin (HGB) and red blood cell count (RBC) by approximately 6%. However, the average values remained above the anemia threshold (124.6 g/L > 120 g/L), and no patients required blood transfusion. Acute inflammatory responses were observed, with a 26.5% increase in neutrophils (NEUT) and an 11.4% increase in white blood cell count (WBC), indicating surgical stress. The coagulation system was activated, as evidenced by an 11.7% decrease in platelet count (PLT), which was associated with the release of thrombin at the surgical site (Table 2 ). Table 2 Dynamic Changes in Complete Blood Count Parameters Indicator PreoperativeValue PostoperativeDay1Value Change P-value Hemoglobin (HGB) 132.7 ± 14.2 g/L 124.6 ± 15.1 g/L Decreased by 8.1 g/L (6.1%) < 0.001 Red Blood Cells (RBC) 4.25 ± 0.51×10¹²/L 3.98 ± 0.49×10¹²/L Decreased by 0.27×10¹²/L (6.4%) < 0.001 Neutrophils (NEUT) 4.68 ± 2.15×10⁹/L 5.92 ± 2.43×10⁹/L Increased by 1.24×10⁹/L (26.5%) < 0.001 White Blood Cells (WBC) 6.85 ± 2.97×10⁹/L 7.63 ± 3.12×10⁹/L Increased by 0.78×10⁹/L (11.4%) 0.002 Platelets (PLT) 198.6 ± 58.3×10⁹/L 175.4 ± 61.7×10⁹/L Decreased by 23.2×10⁹/L (11.7%) < 0.001 At 3 months post-surgery, the main urinary symptoms still present were: nocturia ≥ 2 times (28.6%), incomplete emptying (27.6%), and urgency (23.8%). During the 2-year follow-up, 13 patients died due to cardiovascular diseases or non-prostate-related cancers. No patients died due to complications related to prostate blue laser vaporization. The IPSS decreased to 4.3 ± 3.5 (median score 3), with 68% of patients presenting mild symptoms (≤ 5 points). The incidence of urinary difficulty was significantly improved, with only 17.1% still experiencing it. Among the 25 patients who underwent BVP combined with bladder diversion and catheterization, one patient had a post-operative residual urine volume > 50 ml and required long-term bladder diversion. The remaining patients had residual urine volumes < 50 ml, and their bladder diversion tubes were removed. Discussion Patients aged 80 and above typically have numerous and complex comorbidities, and the occurrence of concurrent surgeries is relatively common. A two-year follow-up of postoperative patients revealed that 13 patients died due to causes unrelated to prostate blue laser vaporization, highlighting the risks faced by elderly patients undergoing surgery. In this study, for patients with prostate volumes ranging from 45 to 95 mL, the surgery time for BVP was between 21 and 51 minutes. This is shorter than the surgery time for plasmakinetic bipolar resection of the prostate (PKRP) in patients with prostate volumes ranging from 41.2 to 96.5 mL (35 to 75 minutes) and shorter than thulium laser enucleation of the prostate (ThuLEP) in patients with prostate volumes from 45.7 to 94.7 mL (47 to 85 minutes) [ 19 ] . On the first postoperative day, the hemoglobin (HGB) level dropped by 6.1% (p < 0.001). However, the average postoperative HGB value was 124.6 g/L, which did not reach the threshold for anemia, indicating that blood loss was mild and compensatory. Previous studies have shown that contemporary monopolar transurethral resection of the prostate (TURP) requires blood transfusions in 2% of cases (range: 0–9%) [ 19 ] . Given that BVP is efficient and has a strong hemostatic effect, it is better suited for elderly patients with multiple comorbidities and poorer surgical tolerance. On the first postoperative day, 26.5% of patients (p < 0.001) exhibited an increase in neutrophils (NEUT), though urinalysis did not show significant signs of urinary tract infection. This finding is likely attributed to tissue damage-induced stress [ 20 ] , which aims to promote survival and repair of the body after injury [ 21 ] . However, urinary tract infections are common in elderly patients prior to surgery, so it is important to control infections before performing surgery and to remain vigilant about the risk of postoperative infections. In this study, the average postoperative IPSS score of patients decreased to 4.3, with significant improvements in urination-related symptoms. However, 28.57% of patients still experienced nocturia more than twice a night, 23.8% had symptoms of urgency, and 27.6% reported feelings of incomplete emptying. These issues may be related to age-related degeneration of the bladder detrusor muscle in elderly patients [ 22 , 23 ] . Nevertheless, the proportion of patients with severe urgency or incomplete emptying was relatively low, with only 1.0% experiencing urgency in more than half of their voiding episodes, and 3.9% reporting incomplete emptying in more than half of their voiding episodes. Overall, this treatment significantly improved the daily quality of life for most elderly patients. Elderly patients often suffer from cardiovascular, pulmonary, and renal diseases. Due to decreased physiological reserves and an increased number of underlying medical conditions, the risk of intraoperative and postoperative complications is higher in older patients [ 24 ] , which limits the possibility of surgery. For patients with poor or unsuitable responses to drug treatments (such as α-blockers or 5α-reductase inhibitors) and those with high surgical risks, cystostomy may be chosen to provide long-term or temporary urinary drainage [ 25 ] . However, for patients who rely on long-term cystostomy, there are risks of urinary tract infections (UTIs) and local infections at the stoma site [ 26 , 27 ] , as well as the potential for complications such as bladder distension [ 26 ] . Long-term cystostomy has also been associated with a potential increased risk of bladder cancer [ 28 ] . Additionally, some patients may experience psychological stress post-surgery, which could negatively impact their quality of life [ 29 , 30 ] . The application of BVP in patients with benign prostatic hyperplasia provides a safer and more effective surgical option for elderly patients with high surgical risks, helping to avoid the adverse outcomes of long-term cystostomy. Declarations Competing Interests: The authors declare that there are no competing interests, either financial or non-financial, directly or indirectly related to the work submitted for publication. Funding Statement: This work was supported by the Xianyang City Science and Technology Bureau's Key R&D Program (Project No.: L2023-ZDYF-SF-058). Ethical Approval: All human studies involved in this research were reviewed and approved by the Xianyang Central Hospital Medical Ethics Committee (Approval No.: 2023-IRB-49). The study adhered to the ethical guidelines set forth by the committee and complied with relevant local and international regulations, including the Declaration of Helsinki. Consent to Participate: Informed consent was obtained from all individual participants involved in the study. Participants were informed about the study’s purpose, procedures, potential risks, and benefits, and their participation was voluntary. Consent to Publish: All participants provided informed consent for the publication of their anonymized data in scientific journals or other public platforms. No personal identifying information was included in any published materials. Clinical Trial Number: Not applicable. References TSANG K K, GARRAWAY W M. Prostatism and the Burden of Benign Prostatic Hyperplasia on Elderly Men [J]. Age and Ageing, 1994, 23(5): 360-4. https://doi.org/10.1093/ageing/23.5.360 GUTHRIE R. Benign prostatic hyperplasia in elderly men [J]. Postgraduate Medicine, 1997, 101(5): 141-62. https://doi.org/10.3810/pgm.1997.05.243 SONG Z, CHENG Z J, YUAN H, et al. Correlation between benign prostatic hyperplasia and comorbidities: a systematic analysis integrating global burden of disease and mendelian randomization study [J]. Journal of Translational Medicine, 2024, 22(1). https://doi.org/10.1186/s12967-024-05604-x BORTNICK E, BROWN C, SIMMA-CHIANG V, et al. Modern best practice in the management of benign prostatic hyperplasia in the elderly [J]. Therapeutic Advances in Urology, 2020, 12. https://doi.org/10.1177/1756287220929486 ABID A, PIPERDI H, BABAR M, et al. Minimally invasive surgical therapies for benign prostatic hyperplasia in the geriatric population: A systematic review [J]. The Prostate, 2024, 84(10): 895-908. https://doi.org/10.1002/pros.24717 PAPET J, CORNU J-N, DUPUIS H. Combination Pharmacotherapy for Benign Prostatic Hyperplasia: Evaluation of Existing Literature on Combination Therapies for Lower Urinary Tract Symptoms Associated with BPH [J]. Drugs & Aging, 2025, 42(6): 527-34. https://doi.org/10.1007/s40266-025-01198-1 KRISHNAMOORTHI R, GANAPATHY A A, HARI PRIYA V M, et al. Future aspects of plant derived bioactive metabolites as therapeutics to combat benign prostatic hyperplasia [J]. Journal of Ethnopharmacology, 2024, 330: 118207. https://doi.org/10.1016/j.jep.2024.118207 HUANG J, FAN Y, WANG K, et al. Transurethral 1470 nm diode laser vaporization versus plasma kinetic enucleation of the prostate for the treatment of benign prostatic hyperplasia: A retrospective study [J]. Medicine, 2023, 102(34). https://doi.org/10.1097/MD.0000000000035031 CERRATO C, JAHRREISS V, NEDBAL C, et al. Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers [J]. Photonics, 2023, 10(6): 635. https://doi.org/10.3390/photonics10060635 SEO D H, KAM S C. Recent advances in laser treatment for benign prostatic hyperplasia [J]. Journal of the Korean Medical Association, 2017, 60(5): 401. https://doi.org/10.5124/jkma.2017.60.5.401 DALTON D C, SHELTON T M, RIVERA M. Laser Technology Advancements in the Treatment of Benign Prostatic Hypertrophy [J]. Current Urology Reports, 2024, 25(4): 71-8. https://doi.org/10.1007/s11934-024-01197-6 SHORBAGY A A, ISMAIL M, KOTB Y M, et al. Laser vs. bipolar prostate vaporization in bleeding-prone patients: a randomized trial and cutting-edge analysis [J]. World Journal of Urology, 2025, 43(1). https://doi.org/10.1007/s00345-025-05692-4 XU X, LIU G, JIANG D, et al. Wound healing process in beagles after vaporization of the prostate with a novel 200W 450-nm laser [J]. Lasers in Medical Science, 2023, 38(1). https://doi.org/10.1007/s10103-023-03888-x ACETO P, ANTONELLI INCALZI R, BETTELLI G, et al. Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus [J]. Aging Clinical and Experimental Research, 2020, 32(9): 1647-73. https://doi.org/10.1007/s40520-020-01624-x SAVIN Z, VEREDGORN Y, TAHA T, et al. En bloc holmium laser enucleation of prostate in octogenarians and nonagenarians: clinical characteristics and outcome [J]. Lasers in Medical Science, 2023, 38(1). https://doi.org/10.1007/s10103-023-03866-3 HASSANZADEH E, GLAZER D I, DUNNE R M, et al. Prostate imaging reporting and data system version 2 (PI-RADS v2): a pictorial review [J]. Abdominal Radiology, 2016, 42(1): 278-89. https://doi.org/10.1007/s00261-016-0871-z KIM D-S, MOON S-K, LIM J-W, et al. The Value of Low Prostate Imaging—Reporting and Data System (PI-RADS) Scores in Preventing Unnecessary Prostate Biopsies [J]. Medicina, 2021, 57(5): 413. https://doi.org/10.3390/medicina57050413 WADA N, WATANABE M, ISHIKAWA M, et al. Uroflowmetry pattern in detrusor underactivity and bladder outlet obstruction in male patients with lower urinary tract symptoms [J]. LUTS: Lower Urinary Tract Symptoms, 2021, 13(3): 361-5. https://doi.org/10.1111/luts.12377 YANG Z, LIU T, WANG X. Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up [J]. Lasers in Medical Science, 2016, 31(9): 1797-802. https://doi.org/10.1007/s10103-016-2052-2 DE FRAITURE E J, RENIERS T, VREEMAN N E W, et al. Neutrophil phenotypes quantify tissue damage caused by major surgery [J]. Frontiers in Surgery, 2025, 12. https://doi.org/10.3389/fsurg.2025.1494831 YANG L, SHI F, CAO F, et al. Neutrophils in Tissue Injury and Repair: Molecular Mechanisms and Therapeutic Targets [J]. MedComm, 2025, 6(5). https://doi.org/10.1002/mco2.70184 NASSAU D E, GERBER J A, WEISS J P. The Prevalence and Treatment of Voiding Dysfunction in the Elderly [J]. Current Geriatrics Reports, 2014, 3(1): 33-41. https://doi.org/10.1007/s13670-013-0075-0 ALDAMANHORI R, CHAPPLE C R. Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors [J]. Current Opinion in Urology, 2017, 27(3): 293-9. https://doi.org/10.1097/MOU.0000000000000381 CHENG E Y, WANG-CHENG R M. Impact of aging on preoperative evaluation [J]. Journal of Clinical Anesthesia, 1991, 3(4): 324-43. https://doi.org/10.1016/0952-8180(91)90230-k KOUDONAS A, ANASTASIADIS A, TSIAKARAS S, et al. Overview of current pharmacotherapeutic options in benign prostatic hyperplasia [J]. Expert Opinion on Pharmacotherapy, 2023, 24(14): 1609-22. https://doi.org/10.1080/14656566.2023.2237406 ZARSKA K, SELVARAJ N, SILVA S D, et al. Herniation of the bladder through suprapubic catheter tract - An unusual complication [J]. Urology Case Reports, 2022. https://doi.org/10.1016/j.eucr.2022.102132 VAIDYANATHAN S, SONI B, HUGHES P, et al. Preventable long-term complications of suprapubic cystostomy after spinal cord injury: Root cause analysis in a representative case report [J]. Patient Safety in Surgery, 2011, 5(1): 27. https://doi.org/10.1186/1754-9493-5-27 SUBRAMANIAM S, THEVARAJAH G, KOLITHA K, et al. Squamous Cell Carcinoma of Suprapubic Cystostomy Site in a Patient with Long-Term Suprapubic Urinary Catheter [J]. Case Reports in Urology, 2017, 2017: 1-5. https://doi.org/10.1155/2017/7940101 PALERMO G, BIZZARRI F P, SCARCIGLIA E, et al. The mental and emotional status after radical cystectomy and different urinary diversion orthotopic bladder substitution versus external urinary diversion after radical cystectomy: A propensity score‐matched study [J]. International Journal of Urology, 2024, 31(12): 1423-8. https://doi.org/10.1111/iju.15586 BAHLBURG H, REICHERZ A, REIKE M, et al. A prospective evaluation of quality of life, psychosocial distress, and functional outcomes two years after radical cystectomy and urinary diversion in 842 German bladder cancer patients [J]. Journal of Cancer Survivorship, 2024, 19(3): 1102-10. https://doi.org/10.1007/s11764-024-01535-0 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 20 Dec, 2025 Read the published version in Lasers in Medical Science → Version 1 posted Editorial decision: Revision requested 06 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers agreed at journal 21 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviews received at journal 18 Sep, 2025 Reviewers agreed at journal 17 Sep, 2025 Reviewers invited by journal 16 Sep, 2025 Editor assigned by journal 16 Sep, 2025 Submission checks completed at journal 10 Sep, 2025 First submitted to journal 04 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7533815","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":518427123,"identity":"06314f93-21a6-4fe0-992f-987bfe63a05f","order_by":0,"name":"Chao Wang","email":"","orcid":"","institution":"Xianyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chao","middleName":"","lastName":"Wang","suffix":""},{"id":518427124,"identity":"1d604467-3db7-458c-a834-8ae61c7eb0c9","order_by":1,"name":"Xiaoliang Fu","email":"","orcid":"","institution":"Xianyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaoliang","middleName":"","lastName":"Fu","suffix":""},{"id":518427125,"identity":"3c1cfcfc-341e-4502-b6d6-95f3f894b500","order_by":2,"name":"Yayun Ji","email":"","orcid":"","institution":"Xianyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yayun","middleName":"","lastName":"Ji","suffix":""},{"id":518427126,"identity":"e8440dec-f290-49cc-bc47-a7d4db0a460a","order_by":3,"name":"Haifeng Cheng","email":"","orcid":"","institution":"Xianyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Haifeng","middleName":"","lastName":"Cheng","suffix":""},{"id":518427127,"identity":"7c5bf11a-8ca4-40b4-8490-3b3bd16ff841","order_by":4,"name":"Guoxiong Liu","email":"","orcid":"","institution":"Xianyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guoxiong","middleName":"","lastName":"Liu","suffix":""},{"id":518427128,"identity":"8c792cae-7b79-4c5b-a9f2-ec11b73982ff","order_by":5,"name":"Zhenwei Fan","email":"","orcid":"","institution":"Xianyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhenwei","middleName":"","lastName":"Fan","suffix":""},{"id":518427129,"identity":"f540c11a-19d4-4627-a9bf-59a237647df1","order_by":6,"name":"Jianing Qiao","email":"","orcid":"","institution":"Xianyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jianing","middleName":"","lastName":"Qiao","suffix":""},{"id":518427130,"identity":"82b72c0a-1286-407c-a110-faf01f248d5d","order_by":7,"name":"Xiaofeng Xu","email":"","orcid":"","institution":"Xianyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaofeng","middleName":"","lastName":"Xu","suffix":""},{"id":518427131,"identity":"7445d035-bf9c-4590-a1d1-a3825138ebec","order_by":8,"name":"Quan Du","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYLACHgYJOXn2xsaHH0jQYmFs2HO42ViCBC0ViQw30tsEeIhRzXcj+dmDt20SCYwzH7YxSDDYyek2ENAieSPN3HBum0Qeu3Ri24MChmRjswMEtBjcSDCT5m2TKGacndhuIMFwIHEbYS3p30BaEhtuHmyT4CFOS44ZRMsNRiK1SJ55UyY555wEMJATgYFsQIRf+I6nb5N4U1YHjMrjDx9+qLCTI6iFAVWBASHlmFpGwSgYBaNgFGABAMcHQpp8dKPcAAAAAElFTkSuQmCC","orcid":"","institution":"Xianyang Central Hospital","correspondingAuthor":true,"prefix":"","firstName":"Quan","middleName":"","lastName":"Du","suffix":""}],"badges":[],"createdAt":"2025-09-04 08:23:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7533815/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7533815/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10103-025-04784-2","type":"published","date":"2025-12-20T15:57:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92152670,"identity":"d4fc66cc-b49c-4ce4-abb9-b8684b3c0c46","added_by":"auto","created_at":"2025-09-25 08:29:10","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1490123,"visible":true,"origin":"","legend":"","description":"","filename":"ApplicationoftransurethralbluelaservaporizationoftheprostateinPatientsAged80andAboveASingleCenterClinicalAnalysisof157Cases.docx","url":"https://assets-eu.researchsquare.com/files/rs-7533815/v1/352c61cea5c57b1925dc2775.docx"},{"id":92152664,"identity":"b7f338b8-0fb5-412d-8853-c55fdc187d3a","added_by":"auto","created_at":"2025-09-25 08:29:10","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9283,"visible":true,"origin":"","legend":"","description":"","filename":"43f020c89b7a4381866c114353c9c3f7.json","url":"https://assets-eu.researchsquare.com/files/rs-7533815/v1/b12b39082fcf0d3a762fad65.json"},{"id":92152667,"identity":"ca6eb874-e585-464b-ae06-cebd78b973fe","added_by":"auto","created_at":"2025-09-25 08:29:10","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70924,"visible":true,"origin":"","legend":"","description":"","filename":"43f020c89b7a4381866c114353c9c3f71enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7533815/v1/1921d4e7309262f73427b53b.xml"},{"id":92152972,"identity":"755af8d1-3c32-4c57-bfa6-c717c48649c7","added_by":"auto","created_at":"2025-09-25 08:37:10","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":659523,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7533815/v1/d7c723dc0ca30fd985314524.jpeg"},{"id":92152668,"identity":"694c6d1f-326f-42dd-bb1b-3bc65fb6cac0","added_by":"auto","created_at":"2025-09-25 08:29:10","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":183446,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7533815/v1/b4e2fc29627f5ffb16d1ea1b.png"},{"id":92152672,"identity":"a1ef2e33-fc7a-4aa3-b332-94d973fa8ead","added_by":"auto","created_at":"2025-09-25 08:29:10","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69538,"visible":true,"origin":"","legend":"","description":"","filename":"43f020c89b7a4381866c114353c9c3f71structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7533815/v1/8ab5ccbfe9f4be5b46337252.xml"},{"id":92152671,"identity":"f6fa8c60-9ce7-47c2-b755-cfdcc2624936","added_by":"auto","created_at":"2025-09-25 08:29:10","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":76646,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7533815/v1/e132cb2aab35fc37725f051f.html"},{"id":92152663,"identity":"1241c02c-f584-4bec-9a92-a9b3f9b93894","added_by":"auto","created_at":"2025-09-25 08:29:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":329714,"visible":true,"origin":"","legend":"\u003cp\u003ea. Postoperative image of a 30ml prostate. b. Postoperative image of a 90ml prostate.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7533815/v1/5c8318ba2c357598ef4732aa.png"},{"id":92152665,"identity":"9790038f-6320-4b83-b555-1dd822b5add2","added_by":"auto","created_at":"2025-09-25 08:29:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19875,"visible":true,"origin":"","legend":"\u003cp\u003eSpectrum of Comorbidities.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7533815/v1/01f46319bca58bcc13f1c0b3.png"},{"id":98814058,"identity":"80a65353-13b7-4dac-9556-54b5fad0c96d","added_by":"auto","created_at":"2025-12-22 16:10:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":968263,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7533815/v1/498800f3-081b-467e-9cc7-52152c770557.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of transurethral blue laser vaporization of the prostate in Patients Aged 80 and Above: A Single-Center Clinical Analysis of 157 Cases","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBenign prostatic hyperplasia (BPH) is a common urological condition affecting the health of elderly men, with its incidence significantly increasing with age\u003csup\u003e[1, 2]\u003c/sup\u003e. Particularly in patients aged 80 years and older, BPH is often accompanied by more severe lower urinary tract symptoms (LUTS) and a higher risk of comorbidities, which makes the selection of appropriate treatment strategies more challenging\u003csup\u003e[3-5]\u003c/sup\u003e. Traditional treatments, such as pharmacotherapy, may be limited in elderly patients due to drug side effects and adherence issues\u003csup\u003e[6, 7]\u003c/sup\u003e. Furthermore, conventional surgical methods, such as transurethral resection of the prostate (TURP), may not be suitable for some elderly, frail patients due to their high invasiveness, longer recovery time, and increased risk of complications\u003csup\u003e[8]\u003c/sup\u003e. Therefore, seeking safe, effective, and minimally invasive treatment options for elderly BPH patients has become an important clinical need.\u003c/p\u003e\n\u003cp\u003eIn recent years, laser technology has been widely applied in the treatment of BPH\u003csup\u003e[9-11]\u003c/sup\u003e. Compared to traditional TURP, laser treatments offer advantages such as reduced bleeding, shorter procedure times, and shorter hospital stays, making them theoretically more suitable for elderly patients with multiple comorbidities\u003csup\u003e[12]\u003c/sup\u003e. Among these laser treatments, transurethral blue laser vaporization of the prostate (BVP) has emerged as a promising minimally invasive approach, demonstrating potential in elderly BPH patients due to its unique benefits\u003csup\u003e[13]\u003c/sup\u003e. Blue laser uses a specific wavelength of laser energy to precisely vaporize hyperplastic prostate tissue, thereby relieving urinary obstruction and improving LUTS.\u003c/p\u003e\n\u003cp\u003eHowever, the physiological characteristics of elderly patients present challenges for blue laser treatment. Elderly patients often have multiple comorbidities, such as cardiovascular and respiratory diseases, which increase the surgical risks and the complexity of perioperative management\u003csup\u003e[14]\u003c/sup\u003e. Therefore, performing blue laser vaporization on elderly BPH patients requires a thorough assessment of their overall health, the development of individualized treatment plans, and enhanced perioperative management to ensure the safety and efficacy of the procedure.\u003c/p\u003e\n\u003cp\u003eSeveral studies have evaluated the application of laser treatments in elderly BPH patients\u003csup\u003e[15]\u003c/sup\u003e. However, due to limitations in sample size, study design, and other factors, especially regarding blue laser, further evidence is needed. This study aims to retrospectively analyze the clinical data of 157 BPH patients aged \u0026ge;80 years who underwent blue laser vaporization at a single center. By evaluating key indicators such as surgical outcomes, postoperative recovery, and complication rates, this study seeks to provide more comprehensive evidence for optimizing treatment strategies for elderly BPH patients.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\n\u003ch3\u003e1. Study Subjects\u003c/h3\u003e\n\u003cp\u003eBetween January 2023 and January 2025, 157 patients aged\u0026thinsp;\u0026ge;\u0026thinsp;80 years with benign prostatic hyperplasia (BPH) were consecutively enrolled at a single center. Inclusion criteria were as follows: patients with a prostate-specific antigen (total PSA) level of 0\u0026ndash;4 ng/ml and a free-to-total PSA ratio greater than 0.16. Patients with abnormal PSA levels were required to undergo prostate MRI 3.0\u0026thinsp;+\u0026thinsp;DWI, and those with a PI-RADS score of 1\u0026ndash;2 were included\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. For patients with a PI-RADS score of 3\u0026ndash;5 on prostate MRI 3.0\u0026thinsp;+\u0026thinsp;DWI, prostate biopsy was required to confirm a benign diagnosis. Patients meeting these criteria were included in the study, while others were excluded. All patients included in the study had pathological samples taken intraoperatively for further screening for prostate cancer. More exclusion criteria included: patients with urine analysis and sediment examination showing bacterial counts exceeding 385/ml, or those with clear urinary tract irritative symptoms that could not be relieved after treatment; patients with a urinary flow dynamics test BOOL value less than 40\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e; and patients with severe dementia, paralysis, hemiplegia, or other similar conditions.\u003c/p\u003e\n\u003ch3\u003e2. Surgical Methods\u003c/h3\u003e\n\u003cp\u003eA total of 116 patients (73.9%) underwent single BVP, using a 450nm blue laser system. During the procedure, the blue laser power was set to 200W, with the system's built-in red light used for hemostasis, set at 50W. Blue laser was applied at five points around the bladder neck to vaporize and remove the hypertrophied prostate tissue, while ensuring protection of the external urethral sphincter and seminal vesicles to avoid injury. After the resection, the patency of the urethral orifice was confirmed, with no significant obstruction observed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A three-way catheter was placed postoperatively, and bladder irrigation was performed for 12 hours. The catheter was removed on the third postoperative day.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTwenty-one patients (13.4%) presented with abnormal bladder compliance and reduced detrusor pressure, and were treated with BVP combined with a bladder stoma catheter insertion. On the 14th postoperative day, the stoma catheter was clamped, and patients were encouraged to attempt spontaneous urination. If the residual urine volume was less than 50ml on each attempt and persisted for one week, the stoma catheter was removed. Fifteen patients (9.6%) developed bladder stones and underwent BVP combined with transurethral bladder pneumatic ballistic lithotripsy. Two patients (1.3%) had both abnormal bladder compliance, reduced detrusor pressure, and bladder stones, and were treated with BVP combined with transurethral bladder pneumatic ballistic lithotripsy and bladder stoma catheter insertion. One patient (0.6%) had a bladder tumor and underwent BVP combined with transurethral bladder lesion resection. One patient (0.6%) presented with abnormal bladder compliance, reduced detrusor pressure, and a bladder tumor, and received BVP, bladder stoma catheter insertion, and transurethral bladder lesion electroresection. One patient (0.6%) had abnormal bladder compliance, reduced detrusor pressure, and unilateral testicular purulent epididymitis, and underwent BVP, bladder stone removal, and unilateral orchiectomy.\u003c/p\u003e\n\u003ch3\u003e3.Observational Indicators\u003c/h3\u003e\n\u003cp\u003eThe following parameters were recorded: patient age, the three-dimensional measurements of the prostate\u0026rsquo;s three diameters and volume (measured using 3D ultrasound), preoperative comorbidities, surgical duration (only the time spent on the BVP procedure), length of hospital stay, postoperative International Prostate Symptom Score (IPSS), complications, and dynamic changes in blood routine tests on the day before and one day after the surgery.\u003c/p\u003e\n\u003ch3\u003e4.Statistical Analysis\u003c/h3\u003e\n\u003cp\u003eData were analyzed using SPSS 26.0 software. Continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Paired t-tests were used for group comparisons. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\n\u003ch3\u003e1.Baseline Characteristics:\u003c/h3\u003e\n\u003cp\u003eThe average age of the patients was 83.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.63 years (range 80\u0026ndash;98 years), with 7.6% (12 cases) being over 90 years old. The prostate-related characteristics of the patients were as follows: left-right diameter 5.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81 cm, superior-inferior diameter 4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15 cm, anterior-posterior diameter 4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85 cm, volume 63.4\u0026thinsp;\u0026plusmn;\u0026thinsp;34.9 ml (range 8.7\u0026ndash;178.1 ml), with a median of 57.6 ml. Among the patients, 25.7% had severe benign prostatic hyperplasia (BPH) with a prostate volume\u0026thinsp;\u0026gt;\u0026thinsp;80 ml.\u003c/p\u003e\u003cp\u003eMore than half of the patients experienced urinary retention, and nearly half had urinary tract infections, which may be closely related to urinary retention. These infections were resolved following anti-infection treatment. One-third of the patients had abnormal PSA levels, but prostate cancer was ruled out through prostate MRI and prostate biopsy. A high proportion of patients had comorbid systemic diseases, including hypoproteinemia (19.1%), mild anemia (15.3%), diabetes (11.5%), chronic bronchitis or emphysema (19.1%), coronary heart disease (15.3%), and heart failure (2.5%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additionally, 5.2% of the patients had abnormal electrocardiogram findings (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMain Types and Proportions of Electrocardiographic Abnormalities.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProportion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTypicalManifestations\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConduction System Abnormalities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBundle branch block, prolonged PR interval\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMyocardial Ischemia Signs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eST-T changes, pathological Q waves\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArrhythmias\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAtrial fibrillation, premature ventricular contractions, sinus arrest\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCardiomyopathy Signs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLeft ventricular hypertrophy, features of cardiomyopathy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e2.Surgery and Hospitalization\u003c/h3\u003e\n\u003cp\u003eThe primary surgical method used was BVP, with 26% of cases requiring additional procedures (such as bladder diversion in 13.4% and bladder stone extraction in 8.3%). Five cases involved a combination of three surgical procedures (specific methods are detailed in the relevant section).\u003c/p\u003e\u003cp\u003eThe average surgical duration was 28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1 minutes (range 8\u0026ndash;69 minutes), with 75% of cases completed within 33 minutes, and 83.3% of cases falling within the 15\u0026ndash;40-minute range. For patients with a prostate volume between 45 and 95 ml, the surgical time ranged from 21 to 51 minutes.\u003c/p\u003e\u003cp\u003eThe median hospitalization duration was 9 days (range 4\u0026ndash;25 days), with 75% of patients staying for 9 days or fewer. The distribution of hospitalization duration was right-skewed, with a peak at 8.5 days.\u003c/p\u003e\n\u003ch3\u003e3.Postoperative Recovery\u003c/h3\u003e\n\u003cp\u003eOn the first postoperative day, there was mild erythrocyte depletion, with a synchronized decrease in hemoglobin (HGB) and red blood cell count (RBC) by approximately 6%. However, the average values remained above the anemia threshold (124.6 g/L\u0026thinsp;\u0026gt;\u0026thinsp;120 g/L), and no patients required blood transfusion. Acute inflammatory responses were observed, with a 26.5% increase in neutrophils (NEUT) and an 11.4% increase in white blood cell count (WBC), indicating surgical stress. The coagulation system was activated, as evidenced by an 11.7% decrease in platelet count (PLT), which was associated with the release of thrombin at the surgical site (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDynamic Changes in Complete Blood Count Parameters\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePreoperativeValue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePostoperativeDay1Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eChange\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin (HGB)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e132.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2 g/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e124.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1 g/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDecreased by 8.1 g/L (6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRed Blood Cells (RBC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u0026times;10\u0026sup1;\u0026sup2;/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u0026times;10\u0026sup1;\u0026sup2;/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDecreased by 0.27\u0026times;10\u0026sup1;\u0026sup2;/L (6.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutrophils (NEUT)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u0026times;10⁹/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u0026times;10⁹/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIncreased by 1.24\u0026times;10⁹/L (26.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite Blood Cells (WBC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u0026times;10⁹/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u0026times;10⁹/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIncreased by 0.78\u0026times;10⁹/L (11.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlatelets (PLT)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e198.6\u0026thinsp;\u0026plusmn;\u0026thinsp;58.3\u0026times;10⁹/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e175.4\u0026thinsp;\u0026plusmn;\u0026thinsp;61.7\u0026times;10⁹/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDecreased by 23.2\u0026times;10⁹/L (11.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAt 3 months post-surgery, the main urinary symptoms still present were: nocturia\u0026thinsp;\u0026ge;\u0026thinsp;2 times (28.6%), incomplete emptying (27.6%), and urgency (23.8%).\u003c/p\u003e\u003cp\u003eDuring the 2-year follow-up, 13 patients died due to cardiovascular diseases or non-prostate-related cancers. No patients died due to complications related to prostate blue laser vaporization. The IPSS decreased to 4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 (median score 3), with 68% of patients presenting mild symptoms (\u0026le;\u0026thinsp;5 points). The incidence of urinary difficulty was significantly improved, with only 17.1% still experiencing it. Among the 25 patients who underwent BVP combined with bladder diversion and catheterization, one patient had a post-operative residual urine volume\u0026thinsp;\u0026gt;\u0026thinsp;50 ml and required long-term bladder diversion. The remaining patients had residual urine volumes\u0026thinsp;\u0026lt;\u0026thinsp;50 ml, and their bladder diversion tubes were removed.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePatients aged 80 and above typically have numerous and complex comorbidities, and the occurrence of concurrent surgeries is relatively common. A two-year follow-up of postoperative patients revealed that 13 patients died due to causes unrelated to prostate blue laser vaporization, highlighting the risks faced by elderly patients undergoing surgery.\u003c/p\u003e\u003cp\u003eIn this study, for patients with prostate volumes ranging from 45 to 95 mL, the surgery time for BVP was between 21 and 51 minutes. This is shorter than the surgery time for plasmakinetic bipolar resection of the prostate (PKRP) in patients with prostate volumes ranging from 41.2 to 96.5 mL (35 to 75 minutes) and shorter than thulium laser enucleation of the prostate (ThuLEP) in patients with prostate volumes from 45.7 to 94.7 mL (47 to 85 minutes)\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. On the first postoperative day, the hemoglobin (HGB) level dropped by 6.1% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the average postoperative HGB value was 124.6 g/L, which did not reach the threshold for anemia, indicating that blood loss was mild and compensatory. Previous studies have shown that contemporary monopolar transurethral resection of the prostate (TURP) requires blood transfusions in 2% of cases (range: 0\u0026ndash;9%)\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Given that BVP is efficient and has a strong hemostatic effect, it is better suited for elderly patients with multiple comorbidities and poorer surgical tolerance.\u003c/p\u003e\u003cp\u003eOn the first postoperative day, 26.5% of patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) exhibited an increase in neutrophils (NEUT), though urinalysis did not show significant signs of urinary tract infection. This finding is likely attributed to tissue damage-induced stress\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, which aims to promote survival and repair of the body after injury\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. However, urinary tract infections are common in elderly patients prior to surgery, so it is important to control infections before performing surgery and to remain vigilant about the risk of postoperative infections.\u003c/p\u003e\u003cp\u003eIn this study, the average postoperative IPSS score of patients decreased to 4.3, with significant improvements in urination-related symptoms. However, 28.57% of patients still experienced nocturia more than twice a night, 23.8% had symptoms of urgency, and 27.6% reported feelings of incomplete emptying. These issues may be related to age-related degeneration of the bladder detrusor muscle in elderly patients\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Nevertheless, the proportion of patients with severe urgency or incomplete emptying was relatively low, with only 1.0% experiencing urgency in more than half of their voiding episodes, and 3.9% reporting incomplete emptying in more than half of their voiding episodes. Overall, this treatment significantly improved the daily quality of life for most elderly patients.\u003c/p\u003e\u003cp\u003eElderly patients often suffer from cardiovascular, pulmonary, and renal diseases. Due to decreased physiological reserves and an increased number of underlying medical conditions, the risk of intraoperative and postoperative complications is higher in older patients\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e, which limits the possibility of surgery. For patients with poor or unsuitable responses to drug treatments (such as α-blockers or 5α-reductase inhibitors) and those with high surgical risks, cystostomy may be chosen to provide long-term or temporary urinary drainage\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. However, for patients who rely on long-term cystostomy, there are risks of urinary tract infections (UTIs) and local infections at the stoma site\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e, as well as the potential for complications such as bladder distension\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Long-term cystostomy has also been associated with a potential increased risk of bladder cancer\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Additionally, some patients may experience psychological stress post-surgery, which could negatively impact their quality of life\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. The application of BVP in patients with benign prostatic hyperplasia provides a safer and more effective surgical option for elderly patients with high surgical risks, helping to avoid the adverse outcomes of long-term cystostomy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eCompeting Interests: The authors declare that there are no competing interests, either financial or non-financial, directly or indirectly related to the work submitted for publication.\u003c/p\u003e\n\u003cp\u003eFunding Statement: This work was supported by the Xianyang City Science and Technology Bureau's Key R\u0026amp;D Program (Project No.: L2023-ZDYF-SF-058).\u003c/p\u003e\n\u003cp\u003eEthical Approval: All human studies involved in this research were reviewed and approved by the Xianyang Central Hospital Medical Ethics Committee (Approval No.: 2023-IRB-49). The study adhered to the ethical guidelines set forth by the committee and complied with relevant local and international regulations, including the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent to Participate: Informed consent was obtained from all individual participants involved in the study. Participants were informed about the study’s purpose, procedures, potential risks, and benefits, and their participation was voluntary.\u003c/p\u003e\n\u003cp\u003eConsent to Publish: All participants provided informed consent for the publication of their anonymized data in scientific journals or other public platforms. No personal identifying information was included in any published materials.\u003c/p\u003e\n\u003cp\u003eClinical Trial Number: Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTSANG K K, GARRAWAY W M. Prostatism and the Burden of Benign Prostatic Hyperplasia on Elderly Men [J]. Age and Ageing, 1994, 23(5): 360-4. https://doi.org/10.1093/ageing/23.5.360\u003c/li\u003e\n\u003cli\u003eGUTHRIE R. Benign prostatic hyperplasia in elderly men [J]. Postgraduate Medicine, 1997, 101(5): 141-62. https://doi.org/10.3810/pgm.1997.05.243\u003c/li\u003e\n\u003cli\u003eSONG Z, CHENG Z J, YUAN H, et al. Correlation between benign prostatic hyperplasia and comorbidities: a systematic analysis integrating global burden of disease and mendelian randomization study [J]. Journal of Translational Medicine, 2024, 22(1). https://doi.org/10.1186/s12967-024-05604-x\u003c/li\u003e\n\u003cli\u003eBORTNICK E, BROWN C, SIMMA-CHIANG V, et al. Modern best practice in the management of benign prostatic hyperplasia in the elderly [J]. Therapeutic Advances in Urology, 2020, 12. https://doi.org/10.1177/1756287220929486\u003c/li\u003e\n\u003cli\u003eABID A, PIPERDI H, BABAR M, et al. Minimally invasive surgical therapies for benign prostatic hyperplasia in the geriatric population: A systematic review [J]. The Prostate, 2024, 84(10): 895-908. https://doi.org/10.1002/pros.24717\u003c/li\u003e\n\u003cli\u003ePAPET J, CORNU J-N, DUPUIS H. Combination Pharmacotherapy for Benign Prostatic Hyperplasia: Evaluation of Existing Literature on Combination Therapies for Lower Urinary Tract Symptoms Associated with BPH [J]. Drugs \u0026amp;amp; Aging, 2025, 42(6): 527-34. https://doi.org/10.1007/s40266-025-01198-1\u003c/li\u003e\n\u003cli\u003eKRISHNAMOORTHI R, GANAPATHY A A, HARI PRIYA V M, et al. Future aspects of plant derived bioactive metabolites as therapeutics to combat benign prostatic hyperplasia [J]. Journal of Ethnopharmacology, 2024, 330: 118207. https://doi.org/10.1016/j.jep.2024.118207\u003c/li\u003e\n\u003cli\u003eHUANG J, FAN Y, WANG K, et al. Transurethral 1470\u0026thinsp;nm diode laser vaporization versus plasma kinetic enucleation of the prostate for the treatment of benign prostatic hyperplasia: A retrospective study [J]. Medicine, 2023, 102(34). https://doi.org/10.1097/MD.0000000000035031\u003c/li\u003e\n\u003cli\u003eCERRATO C, JAHRREISS V, NEDBAL C, et al. Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers [J]. Photonics, 2023, 10(6): 635. https://doi.org/10.3390/photonics10060635\u003c/li\u003e\n\u003cli\u003eSEO D H, KAM S C. Recent advances in laser treatment for benign prostatic hyperplasia [J]. Journal of the Korean Medical Association, 2017, 60(5): 401. https://doi.org/10.5124/jkma.2017.60.5.401\u003c/li\u003e\n\u003cli\u003eDALTON D C, SHELTON T M, RIVERA M. Laser Technology Advancements in the Treatment of Benign Prostatic Hypertrophy [J]. Current Urology Reports, 2024, 25(4): 71-8. https://doi.org/10.1007/s11934-024-01197-6\u003c/li\u003e\n\u003cli\u003eSHORBAGY A A, ISMAIL M, KOTB Y M, et al. Laser vs. bipolar prostate vaporization in bleeding-prone patients: a randomized trial and cutting-edge analysis [J]. World Journal of Urology, 2025, 43(1). https://doi.org/10.1007/s00345-025-05692-4\u003c/li\u003e\n\u003cli\u003eXU X, LIU G, JIANG D, et al. Wound healing process in beagles after vaporization of the prostate with a novel 200W 450-nm laser [J]. Lasers in Medical Science, 2023, 38(1). https://doi.org/10.1007/s10103-023-03888-x\u003c/li\u003e\n\u003cli\u003eACETO P, ANTONELLI INCALZI R, BETTELLI G, et al. Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus [J]. Aging Clinical and Experimental Research, 2020, 32(9): 1647-73. https://doi.org/10.1007/s40520-020-01624-x\u003c/li\u003e\n\u003cli\u003eSAVIN Z, VEREDGORN Y, TAHA T, et al. En bloc holmium laser enucleation of prostate in octogenarians and nonagenarians: clinical characteristics and outcome [J]. Lasers in Medical Science, 2023, 38(1). https://doi.org/10.1007/s10103-023-03866-3\u003c/li\u003e\n\u003cli\u003eHASSANZADEH E, GLAZER D I, DUNNE R M, et al. Prostate imaging reporting and data system version 2 (PI-RADS v2): a pictorial review [J]. Abdominal Radiology, 2016, 42(1): 278-89. https://doi.org/10.1007/s00261-016-0871-z\u003c/li\u003e\n\u003cli\u003eKIM D-S, MOON S-K, LIM J-W, et al. The Value of Low Prostate Imaging\u0026mdash;Reporting and Data System (PI-RADS) Scores in Preventing Unnecessary Prostate Biopsies [J]. Medicina, 2021, 57(5): 413. https://doi.org/10.3390/medicina57050413\u003c/li\u003e\n\u003cli\u003eWADA N, WATANABE M, ISHIKAWA M, et al. Uroflowmetry pattern in detrusor underactivity and bladder outlet obstruction in male patients with lower urinary tract symptoms [J]. LUTS: Lower Urinary Tract Symptoms, 2021, 13(3): 361-5. https://doi.org/10.1111/luts.12377\u003c/li\u003e\n\u003cli\u003eYANG Z, LIU T, WANG X. Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up [J]. Lasers in Medical Science, 2016, 31(9): 1797-802. https://doi.org/10.1007/s10103-016-2052-2\u003c/li\u003e\n\u003cli\u003eDE FRAITURE E J, RENIERS T, VREEMAN N E W, et al. Neutrophil phenotypes quantify tissue damage caused by major surgery [J]. Frontiers in Surgery, 2025, 12. https://doi.org/10.3389/fsurg.2025.1494831\u003c/li\u003e\n\u003cli\u003eYANG L, SHI F, CAO F, et al. Neutrophils in Tissue Injury and Repair: Molecular Mechanisms and Therapeutic Targets [J]. MedComm, 2025, 6(5). https://doi.org/10.1002/mco2.70184\u003c/li\u003e\n\u003cli\u003eNASSAU D E, GERBER J A, WEISS J P. The Prevalence and Treatment of Voiding Dysfunction in the Elderly [J]. Current Geriatrics Reports, 2014, 3(1): 33-41. https://doi.org/10.1007/s13670-013-0075-0\u003c/li\u003e\n\u003cli\u003eALDAMANHORI R, CHAPPLE C R. Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors [J]. Current Opinion in Urology, 2017, 27(3): 293-9. https://doi.org/10.1097/MOU.0000000000000381\u003c/li\u003e\n\u003cli\u003eCHENG E Y, WANG-CHENG R M. Impact of aging on preoperative evaluation [J]. Journal of Clinical Anesthesia, 1991, 3(4): 324-43. https://doi.org/10.1016/0952-8180(91)90230-k\u003c/li\u003e\n\u003cli\u003eKOUDONAS A, ANASTASIADIS A, TSIAKARAS S, et al. Overview of current pharmacotherapeutic options in benign prostatic hyperplasia [J]. Expert Opinion on Pharmacotherapy, 2023, 24(14): 1609-22. https://doi.org/10.1080/14656566.2023.2237406\u003c/li\u003e\n\u003cli\u003eZARSKA K, SELVARAJ N, SILVA S D, et al. Herniation of the bladder through suprapubic catheter tract - An unusual complication [J]. Urology Case Reports, 2022. https://doi.org/10.1016/j.eucr.2022.102132\u003c/li\u003e\n\u003cli\u003eVAIDYANATHAN S, SONI B, HUGHES P, et al. Preventable long-term complications of suprapubic cystostomy after spinal cord injury: Root cause analysis in a representative case report [J]. Patient Safety in Surgery, 2011, 5(1): 27. https://doi.org/10.1186/1754-9493-5-27\u003c/li\u003e\n\u003cli\u003eSUBRAMANIAM S, THEVARAJAH G, KOLITHA K, et al. Squamous Cell Carcinoma of Suprapubic Cystostomy Site in a Patient with Long-Term Suprapubic Urinary Catheter [J]. Case Reports in Urology, 2017, 2017: 1-5. https://doi.org/10.1155/2017/7940101\u003c/li\u003e\n\u003cli\u003ePALERMO G, BIZZARRI F P, SCARCIGLIA E, et al. The mental and emotional status after radical cystectomy and different urinary diversion orthotopic bladder substitution versus external urinary diversion after radical cystectomy: A propensity score‐matched study [J]. International Journal of Urology, 2024, 31(12): 1423-8. https://doi.org/10.1111/iju.15586\u003c/li\u003e\n\u003cli\u003eBAHLBURG H, REICHERZ A, REIKE M, et al. A prospective evaluation of quality of life, psychosocial distress, and functional outcomes two years after radical cystectomy and urinary diversion in 842 German bladder cancer patients [J]. Journal of Cancer Survivorship, 2024, 19(3): 1102-10. https://doi.org/10.1007/s11764-024-01535-0\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"lasers-in-medical-science","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"lims","sideBox":"Learn more about [Lasers in Medical Science](https://link.springer.com/journal/10103)","snPcode":"10103","submissionUrl":"https://submission.springernature.com/new-submission/10103/3","title":"Lasers in Medical Science","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"blue laser vaporization, benign prostatic hyperplasia, advanced age, clinical Analysis","lastPublishedDoi":"10.21203/rs.3.rs-7533815/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7533815/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e This study aims to assess the safety and effectiveness of transurethral blue laser prostate vaporization (BVP) for elderly patients (≥80 years) with benign prostatic hyperplasia (BPH), focusing on clinical outcomes, recovery, and complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective analysis was performed on 157 BPH patients aged ≥80 years who underwent BVP at a single center between May 2023 and May 2025. Data on demographics, prostate volume, comorbidities, procedure details, and postoperative outcomes were collected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe mean age was 83.97±3.63 years, with an average prostate volume of 63.34±34.95 ml. Patients had an average of 2.5 comorbidities, and 26.1% required additional surgical interventions. The average procedure time was 28.2±12.1 minutes, with a median hospital stay of 9 days. Postoperative IPSS scores decreased significantly to 4.3±3.5. Mild red blood cell loss (hemoglobin decreased by 6.1%, p\u0026lt;0.001) and a significant inflammatory response (neutrophils increased by 26.5%, p\u0026lt;0.001) were observed, but no transfusion was needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eTransurethral blue laser prostate vaporization is a safe and effective option for elderly BPH patients with multiple comorbidities, offering significant symptom improvement with minimal postoperative complications.\u003c/p\u003e","manuscriptTitle":"Application of transurethral blue laser vaporization of the prostate in Patients Aged 80 and Above: A Single-Center Clinical Analysis of 157 Cases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-25 08:29:05","doi":"10.21203/rs.3.rs-7533815/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-06T14:36:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T12:30:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256108975351062244298270036295027201854","date":"2025-10-01T14:45:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312009955730351037002117538076999323171","date":"2025-10-01T01:50:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334739657595306774342975582165764658560","date":"2025-09-22T03:31:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"240932904799869447558042588432409121846","date":"2025-09-18T17:48:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-18T07:27:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"163600617294072432838060146738668585560","date":"2025-09-17T08:20:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-16T17:14:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T17:07:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-10T12:19:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Lasers in Medical Science","date":"2025-09-04T08:19:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"lasers-in-medical-science","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"lims","sideBox":"Learn more about [Lasers in Medical Science](https://link.springer.com/journal/10103)","snPcode":"10103","submissionUrl":"https://submission.springernature.com/new-submission/10103/3","title":"Lasers in Medical Science","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"439f71e0-1f0d-4eec-98f8-60685ee28e85","owner":[],"postedDate":"September 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:04:53+00:00","versionOfRecord":{"articleIdentity":"rs-7533815","link":"https://doi.org/10.1007/s10103-025-04784-2","journal":{"identity":"lasers-in-medical-science","isVorOnly":false,"title":"Lasers in Medical Science"},"publishedOn":"2025-12-20 15:57:43","publishedOnDateReadable":"December 20th, 2025"},"versionCreatedAt":"2025-09-25 08:29:05","video":"","vorDoi":"10.1007/s10103-025-04784-2","vorDoiUrl":"https://doi.org/10.1007/s10103-025-04784-2","workflowStages":[]},"version":"v1","identity":"rs-7533815","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7533815","identity":"rs-7533815","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}