Photoselective Vaporization of the Prostate with the 120-W Lithium Triborate Laser in Men Taking Coumadin

Abstract

To 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. From a prospective database of men treated with the 120-W lithium triborate (LBO) laser from November 2006 to July 2010, 43 men were identified to have been on coumadin during their PVP. The mean age was 73.4 years (range, 55-90) and mean prostate size was 75.3 mL (range, 20-227). Perioperative morbidity and early functional outcomes were examined. No men required a blood transfusion, although 2 of 43 (4.7%) men had prolonged catheterization for bleeding. No patient required discontinuation of the coumadin during the perioperative period. Urinary tract infection occurred in 4 (9.3%) and recatheterization in 6 (14%). Apart from 3 outliers, the mean postoperative length of stay was 21.6 hours. At 3 months, improvements in International Prostate Symptom Score, peak urinary flow rate, and postvoid residual were similar to previously reported series of men not taking an anticoagulant. PVP in this high-risk group of patients has low perioperative morbidity and is associated with good early functional outcomes.