1562: Photoselective Vaporization of the Prostate (PVP) in Anticoagulated Patients: A Multicenter Retrospective Evaluation of Feasibility

Abstract

METHODS: A retrospective analysis of 164 consecutive patients with urinary retention who underwent HoLEP between January 2000 and August 2004 was performed.RESULTS: The mean patient age was 72.1 years (range, 34 to 95). The mean duration of urinary retention was 2S.9 days (range, 2 to 365). Preoperative transrectal ultrasound measured prostate volume was 107.14 cc (range, 5 to 242). The mean enucleation and morcellation times were 97.S7 minutes (range, 12 to 4SS) and 22.04 minutes (range, 3 to 120), respectively. The mean weight of resected tissue was Sl.9 grams (range, 2.5 to 271 ). Pathologic evaluation of the tissue demonstrated benign prostatic hyperplasia in 154, and adenocarcinoma in 10 (Gleason 3+3 in S patients and 3+4 in 2 patients). The mean duration of post-operative catheterization and hospitalization was 22.4S hours (range, 2 to 240) and 34.54 hours (range, 2 to 336), respectively. Peri-operative complications included: 1 (0.5%) self-limited re-catheterization due to urinary retention which resolved without an additional procedure, 2 (1.0%) clot retention episodes requiring temporary repeat catheterization, and blood transfusion in 3 patients. Postoperative uroflows were recorded for 60 patients at the 6 month follow-up visit, with a mean maximum flow of 24.15 cc/second (range, 4.3 to 54.S). Postoperative AUA symptom scores were recorded for the same 60 patients, with a mean score of 4.0 (range, 0 to 25).CONCLUSIONS: HoLEP is a safe and effective treatment for patients with urinary retention, even in men with very large prostates. All of the patients in this consecutive series were able to void following treatment, and are currently maintained catheter-free. These results, as well as the large amount of prostatic tissue enucleated, suggest that HoLEP may be the ideal treatment for men suffering from urinary retention due to benign prostatic obstruction.

Perioperative adverse events in patients on continued anticoagulation undergoing photoselective vaporisation of the prostate with the 180‐W Greenlight lithium triborate laser

“…Importantly, no men required a blood transfusion and there were no thromboembolic events. This finding is supported by previously published reports demonstrating that anticoagulant use in men undergoing PVP using the 80-W and 120-W lasers is not associated with increased perioperative morbidity [5][6][7][8][9]. One study investigated a small cohort of patients undergoing PVP using the 80-W KTP laser, of which two patients were on ongoing clopidogrel, 14 on ongoing aspirin and eight on discontinued warfarin [12].…”

“…PVP has an advantage over TURP, due to its haemostatic properties, and has been shown to be a safe alternative treatment for patients receiving therapeutic anticoagulation. The use of the most recent technology, the 180-W lithium triborate (LBO) laser, has been justified based on the safety profile reported with the use of earlier generation lasers [5][6][7][8][9]. However, it should not be assumed that the 180-W LBO laser is equivalent to its predecessors in terms of adverse events (AEs) given that the current laser is significantly more powerful than its predecessors.…”

Current state of the art photoselective vaporization prostatectomy: laser therapy for benign prostatic hyperplasia

“…This experience was expanded and further confirmed in a multicenter study of 83 patients by Malloy et al 12 at the 2005 AUA meeting. Eighty-one such patients had a measurable hematologic deficiency at the time of surgery.…”

Transurethral Incision of the Bladder Neck Using KTP in the Treatment of Bladder Neck Obstruction in Women

“…The post-voiding residual urine volume decreased from 97.56 to 23.6 ml at same time. With regard to safety, the initial test of the efficacy and safety of the 80-watt KTP series in high-risk anticoagulated patients was later expanded to 83 patients by Malloy et al [15] . Eighty-one of the patients had a measurable hematologic deficiency at the time of surgery.…”