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Abstract
PurposeTo compare effectiveness and safety of transurethral diode laser vaporization of prostate (diode LVP) versus bipolar transurethral vaporization of prostate (B-TUVP) in symptomatic benign prostatic hyperplasia (BPH) patients receiving oral anticoagulants/anti-platelet drugs.Patients and methodsAll symptomatic prostate patients receiving oral anticoagulants/anti-platelet drugs are prospectively enrolled in the study between January 2023 to May 2024 in our institution. Of total 98 patients were randomized to B-TUVP (48 patients) or diode LVP (50 patients). The primary outcome is to compare B-TUVP with diode LVP regarding operative bleeding and postoperative hemoglobin drop. Secondary outcomes assess time of urinary irrigation, time of urethral catheter removal, length of hospital stays, and 6-month postoperative functional outcomes; IPSS, postoperative flow rate, and postvoid residual urine.ResultsBaseline characteristics were similar in both groups. Diode LVP group had a significantly higher postoperative hemoglobin with a lower drop compared to B-TUVP group (p = 0.032, p = 0.007; respectively). The diode LVP group had a significantly reduced urinary irrigation duration compared to the B-TUVP group (p = 0.031). Also, diode LVP patients had early catheter removal compared to those in the B-TUVP group (p = 0.014). Additionally, the diode group had a notably reduced hospital stay duration compared to the B-TUVP group (p = 0.024). There were no significant differences between both groups regarding 6-month postoperative IPSS, Q max and PVRU.ConclusionDiode LVP of the prostate is a safer alternative for treating BPH with fewer risks compared to B-TUVP especially in patients receiving anticoagulants. Nonetheless, both treatments yield similar 6-months functional outcomes.
Highlights
Benign prostatic hyperplasia (BPH) prevalence increases with age, affecting a significant portion of older males requiring treatment [1]
Bipolar and laser energy modalities are being increasingly adopted for prostate tissue resection, vaporization, ablation, or enucleation [4–6]
Laser technologies have taken over the field of prostate resection, for high-risk patients prone to bleeding or those on anticoagulants
Summary
Benign prostatic hyperplasia (BPH) prevalence increases with age, affecting a significant portion of older males requiring treatment [1]. Transurethral resection of the prostate (TURP) remains the standard surgical approach; concerns exist regarding perioperative bleeding [2], in patients with risk factors like diabetes, anticoagulation, and constipation [3]. The potential for complications such as prolonged catheterization, rehospitalization for bleeding, and electrolyte imbalances has increased interest in modern surgical technologies. Bipolar and laser energy modalities are being increasingly adopted for prostate tissue resection, vaporization, ablation, or enucleation [4–6]. Laser technologies have taken over the field of prostate resection, for high-risk patients prone to bleeding or those on anticoagulants. The primary laser methods in use today include LBO (lithium borate), Diode lasers, Holmium yttrium–aluminum-garnet laser (Ho-YAG), Thulium fiber laser (TFL), and Thulium YAG (Tm-YAG) [7]
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