Abstract
PurposeWe evaluated efficacy and safety profile of patients with anticoagulation therapy (AT) undergoing holmium laser enucleation of the prostate (HoLEP).MethodsWithin our prospective institutional database (11/2017 to 11/2019), we analyzed functional outcomes and 30-day complication rates of HoLEP patients according to Clavien–Dindo classification (CLD), stratified according to specific AT vs. no AT. Further analyses consisted of uni- and multivariate logistic regression models (LRM) predicting complications.ResultsOf 268 patients undergoing HoLEP, 104 (38.8%) received AT: 25.7% were treated with platelet aggregation inhibitors (PAI), 8.2% with new oral anticoagulants (NOAC) and 4.9% with AT-combinations or coumarins bridged with low molecular weight heparins (LMWH/combination). Patients receiving AT were significantly more comorbid (p < 0.01). Pre- and postoperative maximal flow rates, residual void urine and IPSS at 3 months after surgery were invariably improved after HoLEP for patients with/ without AT. Overall complication rate was 19.5% in patients with no AT vs. 26.1% vs. 27.3 vs. 46.2%, respectively, in patients with PAI, NOAC and LMWH/combination (p < 0.01). Major complications (CLD ≥ 3b) occurred in 6.1% of no AT patients vs. 4.3% vs. 4.5 vs. 0% in patients with PAI, NOAC and LMWH/combination, respectively (p < 0.01). In multivariate LRM, AT was not significantly associated with higher complication rates, whereas high ASA status (OR 2.2, p = 0.04), age (OR 1.04, p = 0.02) and bioptical or incidental prostate cancer (OR 2.5, p = 0.01) represented independent risk factors.ConclusionDespite higher overall complication rates in AT patients, major complications were not more frequent in AT patients. HoLEP is safe and effective in anticoagulated patients.
Highlights
Bladder outlet obstruction (BOO) represents a frequent condition in older men and its prevalence is increasing with higher age [1, 2]
holmium laser enucleation of the prostate (HoLEP) is associated with fewer bleeding complications and shorter hospitalization rate compared to TURP and open retropubic enucleation of the prostate [9,10,11]
Acetylsalicylic acid (ASS) and platelet aggregation inhibitors (PAI, such as clopidogrel) were grouped as PAI, the second group consisted of new oral anticoagulants (NOAC; such as dabigatran, a direct thrombin inhibitor, or oral direct factor Xa inhibitors, such as rivaroxaban or apixaban), patients with low molecular weight heparins (LMWH), or bridged with LMWH as substitution for Vitamin K antagonists (Coumarins) or any combination agents were registered among “LMWH/combination”
Summary
Bladder outlet obstruction (BOO) represents a frequent condition in older men and its prevalence is increasing with higher age [1, 2]. For decades transurethral resection of the prostate (TURP) has been considered the gold standard endoscopic approach for subvesical desobstruction [6]. It is associated with bleeding complication rates in up to 33% in patients with AT [7]. Safer but effective techniques are warranted, such as the holmium laser enucleation of the prostate (HoLEP) [8]. HoLEP is associated with fewer bleeding complications and shorter hospitalization rate compared to TURP and open retropubic enucleation of the prostate [9,10,11]. Small cohort studies suggested the safety and efficacy of HoLEP in patients with AT
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