Holmium laser enucleation of the prostate: efficacy, safety and preoperative management in patients presenting with anticoagulation therapy

Deuker, Marina; Rührup, Jessica; Karakiewicz, Pierre I.; Welte, Maria-Noemi; Kluth, Luis A.; Banek, Séverine; Roos, Frederik C.; Mandel, Philipp; Chun, Felix K.‐H.; Becker, Andreas

doi:10.1007/s00345-020-03272-2

Cited by 18 publications

(11 citation statements)

References 27 publications

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“…In our study there was no statistical significance regarding the bleeding risk in the different anticoagulants. Similar data were published by Deuker et al, who analysed patients under anticoagulation therapy treated with holmium laser enucleation of the prostate [13]. No higher complication rates were reported.…”

Section: Discussionsupporting

confidence: 83%

Transurethral resection of the prostate in 85+ patients: a retrospective, multicentre study

Lotterstätter¹,

Seklehner

Wimpissinger

et al. 2022

World J Urol

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Purpose To determine the safety and efficacy of transurethral resection of the prostate (TUR-P) in patients 85 years or older. Methods In this retrospective, multicentre study, patients equal or older than 85 years at the time of surgery (2015–2020) were included. Several pre-, peri- and postoperative parameters were collected. The main outcome criterion was spontaneous voiding with a post-void residual (PVR) volume < 100 ml at dismission and at 12 months after surgery. Results One hundred sixty-eight patients (median age: 87 years, interquartile range [IQR]: 86–89) were recruited. The patients took on average 5.2 permanent medications (3–8), 107 (64%) were anticoagulated preoperatively and neurological co-morbidities were present in 29 (17%). The indication for surgery was recurrent urinary retention in 66.3% (n = 110) with a mean retention volume of 849 ml. The mean PVR volume of the remaining 35% was 146 ml. Surgery was successfully completed in all patients. A perioperative surgical revision had to be performed in 3% and 13 patients (7.7%) required blood transfusion. After catheter removal, 85% of patients were able to void spontaneously with a PVR < 100 ml, and 14.3% were dismissed with a catheter. Twelve months data were available for 93 patients (55%). Of this cohort, 78 (83.9%) were able to void spontaneously with a PVR < 100 ml, 12 (12.9%) were on permanent catheterization. One patient (0.6%) died perioperatively. The only significant factor associated with an unsuccessful outcome was the number of permanent medications (6.8 vs. 5.0, p = 0.005). Conclusion This retrospective multicentre study documents the safety and efficacy of TURP (monopolar and bipolar) in the old-old cohort.

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Section: Discussionsupporting

confidence: 83%

Transurethral resection of the prostate in 85+ patients: a retrospective, multicentre study

Lotterstätter¹,

Seklehner

Wimpissinger

et al. 2022

World J Urol

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“…The absence of TE in our study may be connected to the slightly lower rate of this. Deuker et al 16 noted that one patient died in their study in which they analysed the data of 268 HoLEP-treated patients. In this study, noteworthy that the treatment of patients receiving coumadin was stopped 10 days before.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the short-term cessation and early initiation of antithrombotic therapy in high-risk patients undergoing HoLEP procedure for large prostates (> 100 mL): A critical evaluation

İbiş¹,

Tokatlı

2022

Preprint

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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.

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“…Likewise, the analysis of another prospectively assessed institutional database, including 268 patients (38.8% antithrombotic medication), showed no rise in complications for HoLEP and ongoing antithrombotic medication. However, ASA status, age, and prostate cancer were the main risk factors for surgical complications [ 7 ▪ ]. A somewhat different picture is shown by the meta-analysis published by Zheng et al , focusing on HoLEP in patients with ongoing antithrombotic medication.…”

Section: Patients Taking Antithrombotic Medicationmentioning

confidence: 99%

Electrosurgery or laser for benign prostatic enlargement: trumpcard or pitfalls

Pallauf

Herrmann

Oswald

et al. 2021

Current Opinion in Urology

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Purpose of review To summarize and comment on publications of the last 2 years in the field of endoscopic surgery for benign prostatic enlargement, focusing on similarities and differences of laser and electrosurgery. Recent findings Because of good hemostasis and safety, invasive endoscopic surgery has evolved to a choice of treatment for vulnerable patients with ongoing antithrombotic medication and in same-day surgery. Recent publications show a good perioperative course and no deterioration in the postoperative outcome. Furthermore, alterations to the original surgical techniques of resection, enucleation, and vaporization have increased the preservation rate for antegrade ejaculation, advancing them to an appealing choice of treatment for sexually active men. Favorable outcomes can be achieved in both laser and electrosurgery. Only the choice of the surgical technique determines the outcome. Summary Various invasive endoscopic surgical techniques are available, offering different advantages and disadvantages for the patient. All of them can be performed with laser and electrosurgery. Therefore, focusing on the proper choice of surgical technique instead of the energy source will guarantee the patient to benefit most.

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Holmium laser enucleation of the prostate: efficacy, safety and preoperative management in patients presenting with anticoagulation therapy

Cited by 18 publications

References 27 publications

Transurethral resection of the prostate in 85+ patients: a retrospective, multicentre study

Transurethral resection of the prostate in 85+ patients: a retrospective, multicentre study

Evaluation of the short-term cessation and early initiation of antithrombotic therapy in high-risk patients undergoing HoLEP procedure for large prostates (> 100 mL): A critical evaluation

Electrosurgery or laser for benign prostatic enlargement: trumpcard or pitfalls

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