Is Bipolar Radiofrequency Thermotherapy a Reliable Treatment for Benign Prostatic Hyperplasia in Elderly Patients Ineligible for General and Spinal Anesthesia?

Background The objective of this study was to investigate the success and safety of bipolar radiofrequency thermotherapy in the treatment of benign prostatic hyperplasia (BPH) in elderly patients ineligible for general and spinal anesthesia owing to significant comorbidities. Methods A total of 115 patients were included in the study. The cohort consisted of patients who had BPH refractory to medical treatment along with excessive comorbidities, rendering them unsuitable for general and spinal anesthesia. Patients with preoperative diagnoses of prostate cancer, urethral stricture, median lobe, neurogenic bladder, or psychological disorders were excluded from the study. Prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual (PVR), and quality of life (QoL) were reassessed, and prostate volume was measured at postoperative months 3 and 12. Preoperative values were compared with values measured at postoperative months 3 and 12. Perioperative complications were assessed according to the Clavien-Dindo Scoring System. Results The median age of the patients was 73.71 ± 11.23 years (mean ± SD). Comparison of the preoperative values of prostate volume, PSA, IPSS, Qmax, PVR, and QoL with values measured at postoperative months 3 and 12 showed a significant reduction in prostate volume (p=0.001), significant improvement in IPSS (p=0.001), a significant increase in Qmax (p=0.001), a significant decrease in PVR (p=0.001), and significant improvement in QoL (p=0.01). However, no significant change was noted in PSA values (p=0.976). The VAS score was 4 ± 1 (0-10) at postoperative hour 1. In the early postoperative period (30 days), urinary retention was observed in seven patients (6.08%), and urinary tract infection in four patients (3.4%). Clavien grade 4 or grade 5 complications were not observed. Conclusions Bipolar radiofrequency thermotherapy is a successful and safe method for the treatment of BPH in elderly patients who are ineligible for spinal or general anesthesia due to excessive comorbidities.