Thulium Laser Vapoenucleation of the Prostate (ThuVEP) in Men at High Cardiovascular Risk and on Antithrombotic Therapy: A Single-Center Experience

Abstract

Bleeding is the most common complication of transurethral resection of the prostate and simple open prostatectomy, especially in men on antiplatelet/anticoagulant therapy. The present study aimed to evaluate the safety and effectiveness of thulium laser vapoenucleation of the prostate (ThuVEP) for benign prostatic hyperplasia in patients on chronic antithrombotic medications. Between January 2015 and December 2019, 88 men underwent the procedure under antithrombotic agents in our center. The mean age was 74.7 ± 6.1 years. Median prostate volume was 66.5 mL. Patients on oral anticoagulants were bridged to low-molecular-weight heparin (n = 35). Aspirin (n = 39), clopidogrel (n = 10), and ticlopidine (n = 4) were maintained. Of the patients, 69.3% had an American Society of Anesthesiologists score ≥ 3. Blood loss at 24 h was comparable in all groups. Median catheterization length and postoperative stays were 2 and 3 days respectively. Acute cardiovascular events occurred in 2 patients (2.3%). Of the patients, 4 required prolonged bladder irrigation, 2 required blood transfusions, 1 required a cystoscopy for bleeding control, and 1 required a suprapubic cystostomy for blood clot evacuation. No patients died within 30 days of being discharged. Late complications occurred in 3 (3.8%) patients (1 optical urethrotomy and 1 bladder neck incision for stenosis; 1 acute myocardial infarction). All follow-up visits (1, 6, and 12-month) showed a significant improvement in all urinary parameters compared to baseline. ThuVEP appears to be a feasible surgical option in high-risk patients on antithrombotic regimens, with acceptable postoperative morbidity, good functional outcome, and low incidence of medium-term reoperation rate.

A prospective, single‐center, randomized clinical trial to evaluate the efficacy of three types of laser vaporization surgeries using a 180‐W GreenLight XPS laser, a 300‐W diode laser, and a 200‐W thulium laser for the treatment of benign prostatic hyperplasia

“…Additionally, the percentages of patients who needed electrocautery coagulation to control intraoperative bleeding were not significantly different between the three techniques, which also supports our claim that there are no significant differences in hemostatic effect between these techniques. The feasibility of laser ablation for BPH on anticoagulants was elucidated by previous studies 6,15,16 . During this trial, PVP, DVP, and ThuVAP were all performed without severe complications in patients on anticoagulants, suggesting a favorable safety profile for all of these techniques even in high‐risk patients.…”

“…The feasibility of laser ablation for BPH on anticoagulants was elucidated by previous studies. 6,15,16 During this trial, PVP, DVP, and ThuVAP were all performed without severe complications in patients on anticoagulants, suggesting a favorable safety profile for all of these techniques even in high-risk patients.…”

Procedural Intervention for Benign Prostatic Hyperplasia in Men ≥ Age 70 Years – A Review of Published Literature

“…A retrospective single-center study by Castellani et al assessed the safety and efficacy of ThuVEP in 88 men, mean age 74.7 with high cardiovascular risk and taking continuous antithrombotic therapy. 18 69.3% of the patients had an ASA score ≥3. Postoperative complications occurred in 26.1% of patients, with later complications occurring in 3.8% of patients.…”

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

“…There were three groups in the study and no patient showed TE. In a similar study, but with a smaller series, on Thulium Laser Vapoenucleation of the Prostate (ThuVEP), Castellani et al 15 pointed out two early admissions in the intensive care unit and one late myocardial infarction. In our study and the study of Castellani et al, the rate of patients with ASA[?…”