What is Known and Objective: Currently, the safety and efficacy
of Holmium Laser Enucleation of Prostate (HoLEP) in patients with large
prostates (>100 ml) who are at high risk for Thromboembolic
Events (TE) and receiving Antithrombotic Therapy (AT) are controversial.
This study aims to characterise the safety and efficacy of the HoLEP in
patients with large prostates (>100ml) at high risk for TE
resuming AT in the early post-operative period.
Methods: We have reviewed retrospective data for 378
patients with large prostates treated with the HoLEP for symptomatic
benign prostatic hyperplasia between December 2016 and July 2020. One
hundred thirty-four of the patients had been receiving AT. Antiplatelet
(AP) therapy was maintained. Patients taking vitamin K antagonists and
new oral anticoagulants stopped taking the drug 5 and 2 days before the
HoLEP, respectively. Postoperatively, anticoagulants (AC) were resumed
within 24 hours. In patients receiving AT, we have determined
“pre-operative, peri-operative, and post-operative” parameters,
functional outcome, and adverse events for the 3 months after the
operations. Subsequently, we have compared the results of 203 patients
without AT.
Results and Discussion: Patients receiving AC and AP were older
(p=0.015) and had a higher median ASA score (p<0.001).
Objective-voiding parameters (Qmax, PVR) and urinary symptoms (IPSS,
QoL) improved in the three groups (p<0.001). Median
enucleation and morcellation efficiencies were 1.58 (IQR:0.87-3.13) and
5 (IQR:1-8.08), median catheterisation and hospitalisation time was 2
days (IQR:2-3) and 3 days (IQR:3-4), respectively. The peri-operative
results were similar in the three groups. Overall, one patient in the AP
group required blood transfusion at 4 days postoperatively due to clot
retention and significant haemoglobin decrease (p=0.216). There was no
adverse TE in any patient within the 3-months postoperatively.
What is new and Conclusion: In cases with large-sized prostates
posing a high risk of bleeding as well as TE, the HoLEP procedure could
be applied without leaving AP agents in a safe and highly efficient
manner. Additionally, this procedure could be performed following the
cessation of AC treatment with the chance of a quite early initiation of
these agents to limit properly the potential risk of TE.