Photoselective laser vaporization prostatectomy in men receiving anticoagulants.

Abstract

BACKGROUND AND PURPOSE:

Photoselective laser vaporization prostatectomy (PVP) with a high-power KTP laser is a hemostatic procedure for men with symptomatic benign prostatic hyperplasia (BPH). This study demonstrates the feasibility of PVP in men who are receiving anticoagulants.

PATIENTS AND METHODS:

Men treated with PVP for symptomatic BPH between July 2002 and September 2003 who were receiving anticoagulants (N=24) were reviewed retrospectively. Their mean age was 75 years, and the mean prostate volume was 82 cc (range 34-164 cc). Nine men (38%) were in retention, eight (33%) had had a myocardial infarction, seven (29%) had had a cerebrovascular accident, and seven had peripheral vascular disease. Of these men, 8 were on warfarin, 2 on clopidogrel, and 14 on aspirin. Men on warfarin discontinued the drug 2 days prior to surgery and restarted it the day after. The other two drugs were not discontinued. The PVP was performed with an 80 W KTP side-firing laser (Laserscope Greenlight PV) through a 23F continuous-flow cystoscope with normal saline as the irrigant.

RESULTS:

The mean operative time was 101 minutes. No transfusions were required. Most (22; 92%) of the men were discharged without a catheter. The serum hematocrit did not change significantly (40.0% to 38.3%). The International Prostate Symptom Score decreased to 13.6, 10.9, 9.7, and 9.5 at 1, 3, 6, and 12 months from a mean of 18.7 preoperatively. The Qmax increased from 9.0 mL/sec preoperatively to 15.1, 16.3, 20.9, and 20.1 mL/sec at 1, 3, 6, and 12 months. No patients had clinically significant hematuria postoperatively, and none suffered clot retention.

CONCLUSIONS:

Photoselective laser vaporization prostatectomy is a suitable treatment option in men being treated with anticoagulants, who are at high risk for clinically significant bleeding.

• Authors: Jaspreet S Sandhu, Casey K Ng, Ricardo R Gonzalez, Steven A Kaplan, Alexis E Te
• Journal: Journal of endourology (J Endourol) Vol. 19 Issue 10 Pg. 1196-8 (Dec 2005) ISSN: 0892-7790 [Print] United States
• PMID: 16359214 (Publication Type: Journal Article)

Chemical References

• Anticoagulants

Topics

• Aged
• Anticoagulants (adverse effects, therapeutic use)
• Feasibility Studies
• Follow-Up Studies
• Hematocrit
• Hemorrhage
• Humans
• Laser Therapy (methods)
• Male
• Prostatectomy (methods)
• Prostatic Hyperplasia (surgery)
• Retrospective Studies
• Severity of Illness Index