PMID- 37725558
OWN - NLM
STAT- MEDLINE
DCOM- 20231113
LR  - 20231218
IS  - 1557-900X (Electronic)
IS  - 0892-7790 (Linking)
VI  - 37
IP  - 11
DP  - 2023 Nov
TI  - Redefining Clinically Significant Hematuria After Holmium Enucleation of the 
      Prostate.
PG  - 1216-1220
LID - 10.1089/end.2023.0317 [doi]
AB  - Introduction and Objective: Holmium laser enucleation of the prostate (HoLEP) is 
      often offered for symptomatic prostatic enlargement at high risk for bleeding. 
      However, prior studies define clinically significant hematuria (CSH) narrowly as 
      the need for blood transfusion or significant decrease in hemoglobin. We sought 
      to evaluate risk factors contributing to a broader definition of CSH, which may 
      contribute to alteration of clinical course. Methods: We analyzed 164 patients in 
      a prospectively maintained database who underwent HoLEP at a single institution 
      across two surgeons from November 2020 to April 2023. HoLEP was performed using 
      Moses 2.0 (Boston Scientific) laser and the Piranha enucleation system (Richard 
      Wolf). We defined CSH broadly as follows: clot retention, return to operating 
      room, perioperative management variation due to hematuria, or continued gross 
      hematuria past 1 month postoperatively. Univariable and multivariable ANOVAs were 
      used. Multivariable analysis of CSH risk based on the use of antiplatelet (AP) 
      agents or anticoagulants included correction for age, enucleation time (surrogate 
      for case difficulty), and prostate volume. Results: 17.7% (29/164) of our 
      patients developed CSH after HoLEP. Longer enucleation time was a mild risk 
      factor for developing CSH (multivariate odds ratio [OR] 1.01, p = 0.02). The 
      strongest predictor of CSH was the use of anticoagulation or AP agents (OR 2.71 
      p < 0.02 on univariable analysis, OR 2.34 p < 0.02 on multivariable analysis), 
      even when aspirin 81 mg was excluded. Conclusion: With a broadened definition, 
      18% of patients developed CSH following HoLEP, which impacted the clinical 
      course. Our data suggest that the current definition of significant hematuria is 
      too narrow and does not capture many patients whose clinical course is affected 
      by hematuria. While safe, anticoagulants and APs significantly predicted an 
      increased CSH risk, and patients should be counseled accordingly.
FAU - Hines, Laena
AU  - Hines L
AD  - Department of Urology, University of Rochester Medical Center, Rochester, New 
      York, USA.
FAU - Doersch, Karen M
AU  - Doersch KM
AD  - Department of Urology, University of Rochester Medical Center, Rochester, New 
      York, USA.
FAU - Ninomiya, Mark
AU  - Ninomiya M
AD  - University of Rochester School of Medicine and Dentistry, Rochester, New York, 
      USA.
FAU - Jain, Rajat
AU  - Jain R
AD  - Department of Urology, University of Rochester Medical Center, Rochester, New 
      York, USA.
FAU - Quarrier, Scott O
AU  - Quarrier SO
AUID- ORCID: 0000-0002-2546-5264
AD  - Department of Urology, University of Rochester Medical Center, Rochester, New 
      York, USA.
LA  - eng
PT  - Journal Article
DEP - 20231017
PL  - United States
TA  - J Endourol
JT  - Journal of endourology
JID - 8807503
RN  - W1XX32SQN1 (Holmium)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Male
MH  - Humans
MH  - Prostate/surgery
MH  - Holmium
MH  - Hematuria/etiology
MH  - *Transurethral Resection of Prostate
MH  - *Prostatic Hyperplasia/surgery
MH  - Platelet Aggregation Inhibitors
MH  - Anticoagulants/therapeutic use
MH  - *Laser Therapy
MH  - Disease Progression
MH  - *Lasers, Solid-State/therapeutic use
MH  - Treatment Outcome
OTO - NOTNLM
OT  - BPH
OT  - HoLEP
OT  - anticoagulation
OT  - antiplatelet
OT  - hematuria
EDAT- 2023/09/19 18:43
MHDA- 2023/11/13 06:42
CRDT- 2023/09/19 13:14
PHST- 2023/11/13 06:42 [medline]
PHST- 2023/09/19 18:43 [pubmed]
PHST- 2023/09/19 13:14 [entrez]
AID - 10.1089/end.2023.0317 [doi]
PST - ppublish
SO  - J Endourol. 2023 Nov;37(11):1216-1220. doi: 10.1089/end.2023.0317. Epub 2023 Oct 
      17.