INTRODUCTION - Holmium laser enucleation of the prostate (HoLEP) is a well-established technique for the surgical management of benign prostatic hyperplasia (BPH). A significant number of patients who require surgery for BPH are being treated with anticoagulation (AC) or antiplatelet (AP) therapy.
We evaluated the efficacy and morbidity of HoLEP in this population.
MATERIALS AND METHODS - 116 patients who required AC/AP therapy undergoing HoLEP from 1999-2014 were compared to 1558 HoLEP patients who were not on AC/AP therapy (no AC/AP). Patients on intermittent vs continuous AC/AP therapy were also compared.
RESULTS - No significant differences in pre-operative characteristics were found between patients who did and did not receive AC/AP therapy. Intra-operative characteristics were similar except for enucleation time (51 vs 65 minutes, AC/AP v no AC/AP respectively, p < 0.001) and morcellation rate (5 vs 4.5 g/min, AC/AP v no AC/AP respectively, p = 0.02). Post-operative outcomes were comparable in all aspects except for length of hospital stay (27.8 vs 24 hours, p < 0.001) and duration of continuous bladder irrigation (15 vs 13.5 hours, p < 0.001), both of which were longer in the AC/AP group. There was no difference between cohorts in the lowest post-operative hemoglobin or transfusion rate. Two patients (1.9%) in the AC/AP cohort required clot evacuation vs 10 patients (0.7%) in the no AC/AP cohort. Pre-, intra- and post-operative characteristics between patients on continuous versus intermittent AC/AP were not statistically significant, except for specimen weight (55.5 vs. 74.5 grams, p = 0.028) which was greater in the intermittent AC group.
CONCLUSIONS - Other than slight prolongation of duration of bladder irrigation and hospital stay, the intermittent or continuous use of anticoagulant therapy did not adversely affect outcomes of HoLEP suggesting that this approach is an attractive approach for such patients, especially when the prostate is very large.
Journal of endourology / Endourological Society. 2016 Apr 11 [Epub ahead of print]
Marawan El Tayeb, Joseph Jacob, Naeem Bhojani, Elaine Bammerlin, James E Lingeman
Baylor Scott and White Health, 423342, Urology, Temple, Texas, United States ; Indiana University School of Medicine, Urology, Indianapolis, Indiana, United States ; University of Montreal, Urology , 1058 St.Denis , Montreal, Quebec, Canada , H2X3J4 ; Methodist Research Institute, Indianapolis, Indiana, United States ; Indiana University School of Medicine, Dept. of Urology , 1801 North Senate Blvd. , Suite 220 , Indianapolis, Indiana, United States , 46202 ;