2005 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE IN PATIENTS WITH INCREASED RISK OF BLEEDING – 10 YEARS' EXPERIENCE

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (II)1 Apr 20132005 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE IN PATIENTS WITH INCREASED RISK OF BLEEDING – 10 YEARS' EXPERIENCE Malte Rieken, Georg Müller, Gernot Bonkat, Stephen Wyler, Thomas Gasser, and Alexander Bachmann Malte RiekenMalte Rieken Basel, Switzerland More articles by this author , Georg MüllerGeorg Müller Basel, Switzerland More articles by this author , Gernot BonkatGernot Bonkat Basel, Switzerland More articles by this author , Stephen WylerStephen Wyler Basel, Switzerland More articles by this author , Thomas GasserThomas Gasser Basel, Switzerland More articles by this author , and Alexander BachmannAlexander Bachmann Basel, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2424AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Photoselective Vaporization of the Prostate (PVP) is regarded to be especially suitable for patients with increased risk of bleeding. However, large cohorts analyzing the safety and efficacy of PVP in this group of patients are scarce. We present our 10 years' experience with PVP in patients under platelet aggregation inhibition and oral anticoagulation. METHODS Data of 908 patients who underwent PVP at our center between 09/2002 and 10/2012 with the 80-W (09/2002 to 04/2007), 120-W (05/2007 to 09/2010) and 180-W laser (10/2010 to 10/2012) were analyzed. Intraoperative data, perioperative complications, functional outcome, and hospitalization or surgical revision due to bleeding within the first 3 postoperative months were compared between patients with (OAC-Group) and without oral anticoagulation or platelet aggregation inhibition (No OAC-Group). RESULTS Patients matched in preoperative prostate volume, voiding parameters (maximum urine flow, postvoid residual volume) and micturition symptoms (IPSS, QoL). Of the 908 patients, 450 (49.6%) were under treatment with ongoing acetylsalicylic acid (n=264, 29.1%), oral anticoagulation (n=121, 13.3%), Clopidogrel (n=17, 1.9%), two drugs (n=50, 5.5%) or all three drugs (n=6, 0.7%). Duration of Surgery and hospitalization were comparable between the two groups. Energy application per case was significantly higher (240 vs. 221 kJ, p<0.001) and duration of catheterization significantly longer (49 vs. 47 h, p<0.01) in the OAC-Group. Conversion to TURP was necessary in 6.4% (OAC-Group) and 8.3% (No OAC-Group; p=ns). Impaired visibility due to bleeding occurred in 3.3% (OAC-Group) and 9.8% (No OAC-Group; p<0.001). Voiding parameters and micturition symptoms significantly improved (p<0.001), and the PSA-value was significantly reduced (p<0.001) in both groups at three months compared to the preoperative values. Bleeding with the necessity for hospitalization within 3 months after surgery was recorded in 2.7% (OAC-Group) and 0.9% (No OAC-Group; p=0.03). Surgical revision due to bleeding was necessary in 4 (OAC-Group) and 1 patients (No OAC-Group; p=ns). CONCLUSIONS Our case series confirms the intra- and early postoperative safety of PVP in patients with ongoing oral anticoagulation or platelet aggregation inhibition. Thus, PVP can be recommended as safe and effective treatment modality for patients with increased risk of bleeding. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e823-e824 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Malte Rieken Basel, Switzerland More articles by this author Georg Müller Basel, Switzerland More articles by this author Gernot Bonkat Basel, Switzerland More articles by this author Stephen Wyler Basel, Switzerland More articles by this author Thomas Gasser Basel, Switzerland More articles by this author Alexander Bachmann Basel, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...