PMID- 27065437
OWN - NLM
STAT- MEDLINE
DCOM- 20170816
LR  - 20220311
IS  - 1557-900X (Electronic)
IS  - 0892-7790 (Linking)
VI  - 30
IP  - 7
DP  - 2016 Jul
TI  - Holmium Laser Enucleation of the Prostate in Patients Requiring Anticoagulation.
PG  - 805-9
LID - 10.1089/end.2016.0070 [doi]
AB  - 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: One hundred sixteen patients who required AC/AP therapy undergoing HoLEP 
      from 1999 to 2014 were compared with 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 preoperative 
      characteristics were found between patients who did and did not receive AC/AP 
      therapy. Intraoperative characteristics were similar except for enucleation time 
      (51 minutes vs 65 minutes, AC/AP vs no AC/AP, respectively, p < 0.001) and 
      morcellation rate (5 g/min vs 4.5 g/min, AC/AP vs no AC/AP, respectively, 
      p = 0.02). Postoperative outcomes were comparable in all aspects except for 
      length of hospital stay (27.8 hours vs 24 hours, p < 0.001) and duration of 
      continuous bladder irrigation (15 hours 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 postoperative 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 postoperative characteristics between patients on 
      continuous vs intermittent AC/AP were not statistically significant, except for 
      specimen weight (55.5 g vs 74.5 g, p = 0.028), which was greater in the 
      intermittent AC group. CONCLUSION: 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 extremely large.
FAU - El Tayeb, Marawan M
AU  - El Tayeb MM
AD  - 1 Division of Urology, Baylor Scott and White Health , Temple, Texas.
FAU - Jacob, Joseph M
AU  - Jacob JM
AD  - 2 Department of Urology, Indiana University School of Medicine , Indianapolis, 
      Indiana.
FAU - Bhojani, Naeem
AU  - Bhojani N
AD  - 3 Department of Urology, University of Montreal , Montreal, Canada .
FAU - Bammerlin, Elaine
AU  - Bammerlin E
AD  - 4 Methodist Research Institute , Indianapolis, Indiana.
FAU - Lingeman, James E
AU  - Lingeman JE
AD  - 2 Department of Urology, Indiana University School of Medicine , Indianapolis, 
      Indiana.
LA  - eng
PT  - Journal Article
DEP - 20160503
PL  - United States
TA  - J Endourol
JT  - Journal of endourology
JID - 8807503
RN  - 0 (Anticoagulants)
RN  - 0 (Hemoglobins)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - W1XX32SQN1 (Holmium)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - Blood Loss, Surgical
MH  - Blood Transfusion/*statistics & numerical data
MH  - Hemoglobins/metabolism
MH  - Holmium
MH  - Humans
MH  - Laser Therapy/*methods
MH  - Lasers, Solid-State/*therapeutic use
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Postoperative Complications/*epidemiology
MH  - Prostatic Hyperplasia/*surgery
MH  - Therapeutic Irrigation
MH  - Transurethral Resection of Prostate/methods
EDAT- 2016/04/12 06:00
MHDA- 2017/08/17 06:00
CRDT- 2016/04/12 06:00
PHST- 2016/04/12 06:00 [entrez]
PHST- 2016/04/12 06:00 [pubmed]
PHST- 2017/08/17 06:00 [medline]
AID - 10.1089/end.2016.0070 [doi]
PST - ppublish
SO  - J Endourol. 2016 Jul;30(7):805-9. doi: 10.1089/end.2016.0070. Epub 2016 May 3.