Impact des anticoagulants et antiagrégants sur complications hémorragiques chez les patients traités par HoLEP

Branchu, B.; León, Pilar; Fournier, R.; Lasserre, T.; Tambwe, R.; Hoquétis, L.; Joncour, C.; Larré, S.

doi:10.1016/j.purol.2020.04.018

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…It has been shown that antithrombotic therapies have a significant effect on hospitalisation and catheterisation time. 21,22 Likewise, Boeri et al reported a comparatively longer hospital stay and catheter maintenance, while they did not see any difference concerning operation time. 23 HoLEP applied to 116 patients who received continuous and intermittent AT treatment by EI Tayeb et al 12 The transfusion rates were 3.5% for AC patients and 1.6% for the non-AC group, which showed no significant difference.…”

Section: Discussionmentioning

confidence: 96%

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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Section: Discussionmentioning

confidence: 96%

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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Redefining Clinically Significant Hematuria After Holmium Enucleation of the Prostate

Hines,

Doersch,

Ninomiya

et al. 2023

Journal of Endourology

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Holmium laser enucleation of the prostate: a 3-year single-center experience of 173 cases

et al. 2022

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Background Holmium laser enucleation of the prostate (Holep) is a safe, effective, and prostate size-independent procedure for benign prostatic hyperplasia treatment (BPH). Holep has demonstrated comparable long-term outcomes with historical BPH mainstay treatments, namely open prostatectomy or transurethral resection of the prostate, as well as straightforward evidence of its low morbidity. In this study, we aimed to report our 3-year Holep experience based on 173 patients. Methods We conducted a retrospective descriptive single center study utilizing medical charts of 173 patients who underwent Holep between 2017 and 2020. Peri and postoperative measures included prostate volume, peak urinary flow rate (Qmax), prostate specific antigen, catheterization time, hospital stay, and complications. Results The mean age and mean prostate weight at baseline were 71.3 ± 7.8 years and 64.2 g (17 and 380 g), respectively. Holep was associated with a short catheterization time and hospital stay (2.7 and 3 days, respectively). Qmax significantly improved after Holep (8.1 vs 20.4 ml/s, p < 0.05), and results sustained at 06 months postoperatively. Perioperative and postoperative complications were mainly represented by hematuria (29%). However, more than half of these patients were taking anticoagulation drug therapy at the time of surgery. Complications mostly occurred during the early years following Holep’s introduction and tended to decrease with time and experience. Conclusion Holep remains a safe and effective procedure for BPH treatment, with durable long-term results even in clinical settings where the procedure is new. The rate of complications, which is associated with the learning curve, improves with time and experience.

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Impact des anticoagulants et antiagrégants sur complications hémorragiques chez les patients traités par HoLEP

Cited by 3 publications

References 22 publications

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

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

Redefining Clinically Significant Hematuria After Holmium Enucleation of the Prostate

Holmium laser enucleation of the prostate: a 3-year single-center experience of 173 cases

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