Editorial Comment

Abstract

Bleeding, intraoperative or postoperative, is one of the biggest ways to ruin a urologist's day. So, to think of operating on a man's prostate when he is actively taking coumadin “is ridiculous.” That answer would have been the most common response from most of our speciality doctors just a few years ago. This article reproduces results that vaporization of the prostate, now with 120 W lithium Triborate Laser, can be performed safely on patients actively taking coumadin. While this is not my standard care practice, I find it reassuring that in the situation that a man is unable to discontinue his coumadin; this procedure remains a safe option. My standard care practice is to discontinue anticoagulants, such as coumadin, 5 days before prostate laser vaporization, if medically cleared to do so. However, if the patient must remain anticoagulated, I discuss the increased potential bleeding risks of a surgical procedure while on coumadin, and only then, perform the surgery. Photoselective Vaporization of the Prostate with the 120-W Lithium Triborate Laser in Men Taking CoumadinUrologyVol. 78Issue 1PreviewTo specifically evaluate perioperative morbidity associated with men who were taking coumadin and continued on this medication at therapeutic levels for the purposes of the prostate (PVP). Increasing numbers of men are taking coumadin for medical comorbidity and this creates clinical concerns for urologists treating such men with benign prostatic obstruction. Photoselective vaporization of the PVP has been shown to be an effective treatment for men receiving anticoagulation treatment, although previously published studies have evaluated a mix of men on aspirin, coumadin, or clopidogrel. Full-Text PDF ReplyUrologyVol. 78Issue 1PreviewThe ability to treat men with photoselective vaporization of the prostate while on Coumadin makes a great deal sense. We understand well the physics of the laser tissue interaction whereby the 532-nm wavelength is absorbed by human tissue with such efficiency to effect vaporization and to then create beyond this an effective thin layer of coagulation. Our reported experience comes off the back of experience with the 80-W KTP laser, which was the predecessor to the 120-W LBO laser. We became “comfortable” with the ability to perform PVP with the 80-W KTP laser and became convinced that we could not tell whether a man was on Coumadin or not on the basis of intraoperative surgical appearances. Full-Text PDF