Thulium Laser Vaporesection of the Prostate: Can We Operate Without Interrupting Oral Antiplatelet/anticoagulant Therapy?

Overview

Journal Investig Clin Urol

Specialty Urology

Date 2017 May 9

PMID 28480345

Citations 4

Authors

Tarik Emre Sener

Salvatore Buttice

Luciano Macchione

Christopher Netsch

Yiloren Tanidir

Laurian Dragos

Rosa Pappalardo

Carlo Magno

Affiliations

Soon will be listed here.

Abstract

Purpose: Thulium vaporesection of the prostate (ThuVARP) is a new and safe approach for patients receiving anticoagulant therapy in whom transurethral resection of the prostate (TURP) may possess a high bleeding risk. We aimed to demonstrate the efficacy and safety of ThuVARP in patients receiving oral antiplatelet/anticoagulant (OAP/OAC) therapy.

Materials And Methods: A total of 103 patients who underwent ThuVARP between 2011 and 2013 were enrolled in the study. Patients were divided into 2 groups. Group A consisted of 47 patients who underwent low molecular weight heparin (LMWH) bridging and group B consisted of 56 patients who were operated on while receiving OAP/OAC therapy.

Results: The drop in hemoglobin levels in the pre- and postoperative periods was significantly higher in group A than in group B. When subgroups were analyzed, the mean drop in hemoglobin was significantly lower in the warfarin and ticlopidine subgroups of group B than in group A. International Prostate Symptom Scores were significantly lower 3, 12, 18, and 24 months after surgery in group A than in group B. Quality of life scores, maximal flow rate values, and postmicturition residual urine volumes (mL) were similar between the 2 groups. A total of 38 and 41 patients in groups A and B, respectively, had no complications.

Conclusions: Our study showed the safety profile of continuing different OAP/OAC therapies in terms of bleeding problems in patients undergoing ThuVARP. We strongly recommend abandoning LMWH bridging and maintaining the OAP/OAC regimen patients are already receiving.

Citing Articles

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References

Gratzke C, Bachmann A, Descazeaud A, Drake M, Madersbacher S, Mamoulakis C . EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol. 2015; 67(6):1099-1109. DOI: 10.1016/j.eururo.2014.12.038. View

Dotan Z, Mor Y, Leibovitch I, Varon D, Golomb J, Duvdevani M . The efficacy and safety of perioperative low molecular weight heparin substitution in patients on chronic oral anticoagulant therapy undergoing transurethral prostatectomy for bladder outlet obstruction. J Urol. 2002; 168(2):610-3; discussion 614. View

Netsch C, Magno C, Buttice S, Macchione L, Mucciardi G, Herrmann T . Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison. Urol Int. 2016; 96(4):421-6. DOI: 10.1159/000441013. View

Hirayama T, Shitara T, Fujita T, Iwamura M, Kubo S, Baba S . [Holmium laser enucleation of the prostate (HoLEP) in patients with continuous oral anticoagulation: first reported cases in Japan]. Nihon Hinyokika Gakkai Zasshi. 2010; 101(7):754-7. DOI: 10.5980/jpnjurol.101.754. View

Rose A, Allen A, Minichello T . A Call to Reduce the Use of Bridging Anticoagulation. Circ Cardiovasc Qual Outcomes. 2015; 9(1):64-7. DOI: 10.1161/CIRCOUTCOMES.115.002430. View

Yu H, Zhang Z, Zhu Y, Chen J, Jiang X, Meng H . Long-term outcome following thulium vaporesection of the prostate. Lasers Surg Med. 2016; 48(5):505-10. DOI: 10.1002/lsm.22495. View

Roehrborn C, McConnell J, Bonilla J, Rosenblatt S, Hudson P, Malek G . Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study. J Urol. 1999; 163(1):13-20. View

Vincent M, Gilling P . HoLEP has come of age. World J Urol. 2014; 33(4):487-93. DOI: 10.1007/s00345-014-1443-x. View

Cornu J, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C . A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol. 2014; 67(6):1066-1096. DOI: 10.1016/j.eururo.2014.06.017. View

10.

Berger J, Robert G, Descazeaud A . Laser treatment of benign prostatic hyperplasia in patients on oral anticoagulant therapy. Curr Urol Rep. 2010; 11(4):236-41. DOI: 10.1007/s11934-010-0115-7. View

11.

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014; 12(12):1495-9. DOI: 10.1016/j.ijsu.2014.07.013. View

12.

Macchione L, Mucciardi G, Gali A, Di Benedetto A, Buttice S, Magno C . Efficacy and safety of prostate vaporesection using a 120-W 2-μm continuous-wave Tm:YAG laser (RevoLix 2) in patients on continuous oral anticoagulant or antiplatelet therapy. Int Urol Nephrol. 2013; 45(6):1545-51. DOI: 10.1007/s11255-013-0487-y. View

13.

Fu W, Zhang X, Yang Y, Hong B, Gao J, Cai W . Comparison of 2-microm continuous wave laser vaporesection of the prostate and transurethral resection of the prostate: a prospective nonrandomized trial with 1-year follow-up. Urology. 2009; 75(1):194-9. DOI: 10.1016/j.urology.2009.07.1266. View

14.

Rieken M, Ebinger Mundorff N, Bonkat G, Wyler S, Bachmann A . Complications of laser prostatectomy: a review of recent data. World J Urol. 2010; 28(1):53-62. DOI: 10.1007/s00345-009-0504-z. View

15.

Chung D, Wysock J, Lee R, Melamed S, Kaplan S, Te A . Outcomes and complications after 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia. J Urol. 2011; 186(3):977-81. DOI: 10.1016/j.juro.2011.04.068. View

16.

Roehrborn C, Boyle P, BERGNER D, Gray T, Gittelman M, Shown T . Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a four-year, randomized trial comparing finasteride versus placebo. PLESS Study Group. Urology. 1999; 54(4):662-9. DOI: 10.1016/s0090-4295(99)00232-0. View

17.

Bach T, Herrmann T, Ganzer R, Burchardt M, Gross A . RevoLix vaporesection of the prostate: initial results of 54 patients with a 1-year follow-up. World J Urol. 2007; 25(3):257-62. DOI: 10.1007/s00345-007-0171-x. View

18.

Rassweiler J, Teber D, Kuntz R, Hofmann R . Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006; 50(5):969-79. DOI: 10.1016/j.eururo.2005.12.042. View

19.

Ruszat R, Wyler S, Forster T, Reich O, Stief C, Gasser T . Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol. 2006; 51(4):1031-8. DOI: 10.1016/j.eururo.2006.08.006. View

20.

Taylor K, Filgate R, Guo D, Macneil F . A retrospective study to assess the morbidity associated with transurethral prostatectomy in patients on antiplatelet or anticoagulant drugs. BJU Int. 2011; 108 Suppl 2:45-50. DOI: 10.1111/j.1464-410X.2011.10686.x. View