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Outcomes and Complications After 532 nm Laser Prostatectomy in Anticoagulated Patients With Benign Prostatic Hyperplasia

2011; Lippincott Williams & Wilkins; Volume: 186; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2011.04.068

1527-3792

Doreen E. Chung, James Wysock, Richard K. Lee, Scott R. Melamed, Steven A. Kaplan, Alexis E. Te,

Pelvic floor disorders treatments

No AccessJournal of UrologyAdult Urology1 Sep 2011Outcomes and Complications After 532 nm Laser Prostatectomy in Anticoagulated Patients With Benign Prostatic Hyperplasia Doreen E. Chung, James S. Wysock, Richard K. Lee, Scott R. Melamed, Steven A. Kaplan, and Alexis E. Te Doreen E. ChungDoreen E. Chung Section of Urology, University of Chicago and Department of Surgery, Mount Sinai Hospital, Chicago, Illinois , James S. WysockJames S. Wysock Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York , Richard K. LeeRichard K. Lee Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York , Scott R. MelamedScott R. Melamed Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York , Steven A. KaplanSteven A. Kaplan Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York , and Alexis E. TeAlexis E. Te Brady Prostate Center, Weill Cornell Medical College, Cornell University, New York, New York View All Author Informationhttps://doi.org/10.1016/j.juro.2011.04.068AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Patients on anticoagulation are at high risk for bleeding after electrocautery transurethral resection of the prostate or open prostatectomy and they are often denied surgery for symptomatic benign prostatic hyperplasia. Using photoselective vaporization of the prostate, patients at high risk may safely undergo surgery. We explored outcomes and complications after photoselective vaporization of the prostate in an anticoagulated, high risk cohort. Materials and Methods: Between 2002 and 2008, 162 men on systemic anticoagulation underwent photoselective vaporization of the prostate. Data were collected on demographics, comorbidities, complications, serum sodium, hematocrit, maximum flow rate, post-void residual urine, International Prostate Symptom Score and complications. Results: Mean ± SD age was 72 ± 8 years, mean baseline prostate volume was 91 ± 49 gm and mean prostate specific antigen was 4.1 ± 5 ng/ml. Of the patients 31 (19%) were on warfarin, 101 (62%) were on acetylsalicylic acid, 19 (12%) were on clopidogrel and 11 (7%) were on 2 or more anticoagulants. Median American Society of Anesthesiologists class was 3 and mean Charlson comorbidity index was 5. Median operative time was 105 minutes and mean energy use was 280 ± 168 kJ. The immediate mean hematocrit decrease was 1.94% ± 2.42%. One patient who received excessive intravenous fluids experienced heart failure. Complications within 30 days included urinary tract infection in 4 patients (2.5%) and delayed bleeding in 6 (4%). Three of these patients (50%) required blood transfusion and 1 (17%) required reoperation. In 2 years of followup 3 patients (2%) required repeat photoselective vaporization of the prostate. No incontinence or urethral stricture developed. Significant improvements occurred in International Prostate Symptom Score, maximum flow rate and post-void residual urine. Conclusions: Results support using 532 nm photoselective vaporization of the prostate in patients at high risk on systemic anticoagulation, even those on 2 or more anticoagulation agents and with a large prostate requiring longer operative time. Few complications developed and significant durable clinical improvement was seen. References 1 : Laser treatment of benign prostatic hyperplasia in patients on oral anticoagulant therapy: a review. BJU Int2008; 103: 1162. Google Scholar 2 : Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol2006; 50: 969. 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Google Scholar © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHermanns T, Grossmann N, Wettstein M, Fankhauser C, Capol J, Poyet C, Hefermehl L, Zimmermann M, Sulser T and Müller A (2018) Absorption of Irrigation Fluid Occurs Frequently during High Power 532 nm Laser Vaporization of the ProstateJournal of Urology, VOL. 193, NO. 1, (211-216), Online publication date: 1-Jan-2015.Culkin D, Exaire E, Green D, Soloway M, Gross A, Desai M, White J and Lightner D (2018) Anticoagulation and Antiplatelet Therapy in Urological Practice: ICUD/AUA Review PaperJournal of Urology, VOL. 192, NO. 4, (1026-1034), Online publication date: 1-Oct-2014.Meeks J, Maschino A, McVary K and Sandhu J (2018) Clinically Significant Prostate Cancer is Rarely Missed by Ablative Procedures of the Prostate in Men with Prostate Specific Antigen Less Than 4 ng/mlJournal of Urology, VOL. 189, NO. 1, (111-115), Online publication date: 1-Jan-2013.Schroeck F, Hollingsworth J, Kaufman S, Hollenbeck B and Wei J (2018) Population Based Trends in the Surgical Treatment of Benign Prostatic HyperplasiaJournal of Urology, VOL. 188, NO. 5, (1837-1841), Online publication date: 1-Nov-2012. Volume 186Issue 3September 2011Page: 977-981 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordsprostatic hyperplasialaser therapyanticoagulantstransurethral resection of prostateprostateMetricsAuthor Information Doreen E. Chung Section of Urology, University of Chicago and Department of Surgery, Mount Sinai Hospital, Chicago, Illinois More articles by this author James S. Wysock Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York More articles by this author Richard K. Lee Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York More articles by this author Scott R. Melamed Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York More articles by this author Steven A. Kaplan Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York More articles by this author Alexis E. Te Brady Prostate Center, Weill Cornell Medical College, Cornell University, New York, New York Financial interest and/or other relationship with American Medical Systems. More articles by this author Expand All Advertisement PDF downloadLoading ...