Impact of oral anticoagulation on morbidity of transurethral resection of the prostate

Descazeaud, A.; Robert, G.; Lebdai, Souhil; Bougault, Alain; Azzousi, Abdel Rahmene; Haillot, O.; Devonec, M.; Fourmarier, M.; Saussine, C.; Barry-Delongchamps, N.; Taille, Alexandre de la

doi:10.1007/s00345-010-0561-3

Cited by 68 publications

(45 citation statements)

References 17 publications

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“…Shah et al [30] have observed that preoperative prostate volume, intraoperative duration of irrigation, total amount of irrigation fluid used and weight of resected prostatic tissue directly influence the amount of fluid absorption during HoLEP. Finally, the transfusion rates in this study after ThuVEP (3.9%) and ThuVARP (0%) in cardiopulmonary high-risk patients on OA are comparable to PVP (0-2%) [2,11,12,13,14,15,16], HoLEP (0-9.6%) [17,18,31], and lower than in current TURP studies (up to 11%) [6,7,8]. …”

Section: Discussionmentioning

confidence: 99%

“…The surgical management of BPO is complicated by an increasing use of oral anticoagulants (OA) for primary and secondary prevention of cardiovascular complications [2]. However, a controversy exists regarding the performance of TURP under OA: while transfusion rates up to 28.6% have been found in older series [3,4,5], these transfusion rates could not be confirmed in more recent studies with transfusion rates up to 11% [6,7,8]. Various, more minimally invasive laser devices have been introduced as alternatives to TURP for the surgical treatment of BPO during the past 20 years [9,10]: the potassium-titanyl-phosphate (KTP) [2,11,12,13,14,15,16], the holmium:YAG [17,18], and the thulium:YAG [19,20,21] laser.…”

Section: Introductionmentioning

confidence: 85%

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Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

et al. 2015

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Introduction: To evaluate the short-term results of thulium vaporesection of the prostate (ThuVEP) and thulium vapoenucleation of the prostate (ThuVARP) in patients with benign prostatic obstruction on oral anticoagulants (OA). Methods: A 3-centre retrospective matched-paired comparison of patients treated by ThuVEP (n = 26) or ThuVARP (n = 26) was performed. Thirty-four patients were on aspirin/ticlopidin, 7 on clopidogrel or clopidogrel and aspirin, and 11 on phenprocoumon at the time of surgery. Results: Haemoglobin decrease was higher after ThuVEP compared to ThuVARP (1.5 vs. 0.3 g/dl, p < 0.001). The rate of postoperative blood transfusions (3.9 vs. 0%), clot retention (3.9 vs. 0%), and re-operation (7.7 vs. 0%) was not different between ThuVEP and ThuVARP (p = 0.274). Catheterization time was shorter for ThuVARP (1 vs. 2 days, p < 0.01). Q_max was significantly higher after ThuVEP at 6-month follow-up (31 vs. 21.5 ml/s, p < 0.001), while improvements in International Prostate Symptom Score, quality of life, and post-voiding residual urine showed no differences between the groups. Urethral or bladder neck strictures did not occur during the 6-month follow-up in both groups. Conclusions: ThuVEP and ThuVARP are safe and efficacious procedures in patients on OA. Although patients assigned to ThuVEP had higher Q_max at 6-month follow-up, ThuVARP resulted in similar functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 85%

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

et al. 2015

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“…Therefore, the cohort of patients who stopped their medication (n = 105) in the report by Raj et al [16] was too small to draw significant conclusions regarding morbidity. In a multicenter analysis from France, patients undergoing TUR-P under OA were compared to a cohort without OA [2]. Most patients stopped OA or were bridged to heparin.…”

Section: Discussionmentioning

confidence: 99%

“…acetylsalicylic acid and clopidrogel following drug eluting stent in coronary disease or phenprocoumon in atrial fibrillation) because the risk of bleeding complications is significantly elevated [2]. In order to perform TUR-P, the medication is often interrupted or bridged with low-molecular-weight heparin.…”

Section: Introductionmentioning

confidence: 99%

Thulium Laser (Revolix) Vapoenucleation of the Prostate Is a Safe Procedure in Patients with an Increased Risk of Hemorrhage

et al. 2012

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Purpose: To evaluate the feasibility and safety of thulium:yttrium-aluminium-garnet laser vapoenucleation of the prostate (ThuVEP) in patients with chronic anticoagulation and bleeding disorders. Methods: We retrospectively analyzed the clinical data (transfusion rate, hemoglobin changes, residual urine, bleeding complications, complications and residual urine) of patients with chronic anticoagulation and bleeding disorders treated with ThuVEP. Anticoagulation was not paused for surgery. Results: We identified 39 patients who fulfilled the inclusion criteria (32 with chronic anticoagulation, 3 with bleeding disorder, and 4 with both). Mean preoperative hemoglobin was 12.9 g/l; the postoperative hemoglobin was 11.7 g/l. One patient received a blood transfusion. Mean residual urine was 166 ml preoperatively and 47 ml postoperatively, respectively; spontaneous voiding postoperatively was feasible in 36 patients. During follow-up, 5 patients suffered from gross hematuria, which was treated conservatively. Conclusions: ThuVEP is a safe procedure in patients with therapeutic anticoagulation, bleeding disorders and platelet aggregation inhibitor medication.

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“…Oral anticoagulant (OAC) use is increasing. Descazeaud and colleagues reported that 33% of men listed for bladder outlet surgery were taking an OAC [Descazeaud et al 2011]. Although most urologists would recommend stopping these agents perioperatively, this is not without risk, and even if they are stopped there remains a significant risk of bleeding with M-TURP [Tyson and Lerner, 2009].…”

Section: Bipolar-turp (B-turp)mentioning

confidence: 99%

Holmium laser enucleation of the prostate: a paradigm shift in benign prostatic hyperplasia surgery

Aho

2013

Therapeutic Advances in Urology

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Holmium laser enucleation (HoLEP) was developed in the 1990s as a more efficient and cost effective method of benign prostatic hyperplasia surgery than laser vaporization and resection techniques. As a true anatomical enucleation it mimics open prostatectomy and is as durable. There is a significant body of level 1 evidence in support of HoLEP, including 2 metaanalyses and 14 randomized trials which compare HoLEP with a number of other procedures. This review describes the development of and summarizes the evidence for HoLEP.

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Impact of oral anticoagulation on morbidity of transurethral resection of the prostate

Abstract: OA had a significant and independent impact on TURP outcome in terms of bleeding complications. This data could be used for treatment decision and for patient's information prior BPH surgery.

Cited by 68 publications

References 17 publications

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

Thulium Laser (Revolix) Vapoenucleation of the Prostate Is a Safe Procedure in Patients with an Increased Risk of Hemorrhage

Holmium laser enucleation of the prostate: a paradigm shift in benign prostatic hyperplasia surgery

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