Factors Influencing Intraoperative Blood Loss in Patients Undergoing Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Large Multicenter Analysis

Romero-Otero, Javier; García-González, L.; García‐Gómez, Borja; Justo-Quintas, J.; García‐Rojo, Esther; González-Padilla, Daniel A.; Sutil, Raquel Sopeña; Duarte-Ojeda, J.M.; Rodrı́guez-Antolı́n, A.

doi:10.1016/j.urology.2019.06.024

Cited by 26 publications

(21 citation statements)

References 28 publications

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“…5 Literature indicated that the blood transfusion rate was significantly higher in patients who received anticoagulants (9.4% vs. 4.4%, P<0.001), but in patients treated with antiplatelet agents, this trend was not significant (2.9% in antiplatelet receiver vs. 5.7% in nonreceiver, P = 0.320). 33 Despite HoLEP is feasible in choosing patients on an anticoagulant. Given the different mechanisms of action of anticoagulants, 34 it seems to be incorrect to assume that the risk between different agents is similar.…”

Section: Anticoagulationmentioning

confidence: 99%

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Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

et al. 2020

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Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

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Section: Anticoagulationmentioning

confidence: 99%

“…ED was reported in 13% of the patients who underwent TURP. [31][32][33] Some authors 41 believe that ED is age-related, but others attribute it to preexisting ED. 42 Hanbury et al 43 propose that injury to the prostatic capsule and neurovascular bundles during an operation causes erectile dysfunction.…”

Section: Sexual Functionmentioning

confidence: 99%

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

et al. 2020

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“…Intra‐operative and post‐operative haemorrhage requiring blood transfusion is one of the important complications of AEEP, accounting for approximately 1.2%–1.9% of BPO patients (Elmansy, Kotb, & Elhilali, ; Placer et al, ). A large multicenter study recently reported that HoLEP has no remarkable impact on blood loss (Romero‐Otero et al, ). Mean haemoglobin before and after HoLEP decreased from 14.6 to 12.3 g/dl, and mean haematocrit decreased from 44.3% to 37.7% (Romero‐Otero et al, ).…”

Section: Evidence Synthesismentioning

confidence: 99%

“…A large multicenter study recently reported that HoLEP has no remarkable impact on blood loss (Romero‐Otero et al, ). Mean haemoglobin before and after HoLEP decreased from 14.6 to 12.3 g/dl, and mean haematocrit decreased from 44.3% to 37.7% (Romero‐Otero et al, ). Most recently, Ibrahim, Alharbi, Elhilali, Aube, and Carrier () revealed in their prospective research that perioperative blood transfusion was required in merely 0.8% of patients.…”

Section: Evidence Synthesismentioning

confidence: 99%

Complications of anatomical endoscopic enucleation of the prostate

Wei

et al. 2020

Andrologia

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Transurethral resection of the prostate (TURP) remains the 'gold standard' for surgical treatment of benign prostatic obstruction (BPO). Recently, anatomical endoscopic enucleation of the prostate (AEEP) using holmium laser, thulium laser and plasma, etc., is extensively applied in clinical practice. However, perioperative complications of AEEP are inevitable in spite of lower incidence compared with TURP. This study reviewed the literature related to the aetiology, prevention and treatment of common complications of AEEP, which would contribute to the diagnosis and treatment of BPO.

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“…With the aging of the population and the increase of the incidence of cardiovascular and cerebrovascular diseases, the number of BPH patients requiring surgical treatment while taking oral antithrombotic drugs is also increasing year by year, further increasing the risk of perioperative bleeding (7). However, recent studies have found that the type of antithrombotic agents is not a major factor in the risk of perioperative bleeding in patients with BPH (8,9). Meskawi et al (9) treated BPH patients undergoing laser surgery with antiplatelet agents such as clopidogrel acetylsalicylate and anticoagulants such as warfarin, thrombin inhibitors and rivaroxaban.…”

Section: Introductionmentioning

confidence: 99%

Meta‑analysis of the effect of antithrombotic drugs on perioperative bleeding in BPH surgery

Gao

2020

Exp Ther Med

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Effects of antithrombotic agents on the bleeding risk after transurethral resection of the prostate (TURP) were assessed in patients with benign prostatic hyperplasia (BPH). Controlled clinical trials on the effects of perioperative anticoagulant therapy on postoperative bleeding in BPH patients published during January 1990 and February 2019 were searched in PubMed, Embase and the Cochrane Library. Two independent reviewers screened the studies according to the inclusion and exclusion criteria, extracted the data, evaluated the quality, and conducted a meta-analysis using the RevMan 5.3 software. A total of 20 studies were included. Analysis of these studies found that compared with interrupted use of antithrombotic agents, continuous use of antithrombotic drugs led to more frequent post-TURP bleeding (OR=4.34, 95% CI=2.29-8.23), and higher transfusion rate (2.96, 1.19-7.36). Compared with patients who never used antithrombotic agents, those who used antithrombotic agents continuously had higher bleeding risk (5.52, 1.64-18.66). Those who continued using antithrombotic agents during laser treatment had higher transfusion rate than those who stopped using them before the operation (5.39, 1.49-19.53), but it had no significant difference in clot retention, blood transfusion rate, intraoperative hemoglobin decrease and postoperative catheter-indwelling time compared with those who never used antithrombotic agents (P>0.05). Those who continued using antithrombotic agents during TURP showed less intraoperative hemoglobin decrease (-0.46,-0.58-0.35) than the patients who underwent low molecular weight heparin substitution. Interruption of antithrombotic agents during TURP can prevent the risk of postoperative bleeding; continuous use of antithrombotic agents is safe and feasible during laser treatment of BPH; whether low molecular weight heparin substitution is necessary during the discontinuation of antithrombotic agents is controversial.

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Factors Influencing Intraoperative Blood Loss in Patients Undergoing Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Large Multicenter Analysis

Cited by 26 publications

References 28 publications

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

Complications of anatomical endoscopic enucleation of the prostate

Meta‑analysis of the effect of antithrombotic drugs on perioperative bleeding in BPH surgery

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