- 作者：Robin Ruszat ; Stephen Wyler ; Thomas Forster ; Oliver Reich ; Christian G. Stief ; Thomas C. Gasser ; Tullio Sulser ; Alex ; er Bachmann
- 关键词：Benign prostatic hyperplasia ; KTP laser ; Oral anticoagulation ; Photoselective vaporization ; PVP
- 刊名：European Urology
- 出版年：2007
- 期刊代码：289_03022838
- 类别：med
- 出版时间：April 2007
- 卷：51
- 期：4
- 页码：1031-1041
- 文件大小：263 K
Ongoing oral anticoagulation (OA) contraindicates transurethral electroresection of the prostate. We evaluated the safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing OA with coumarin derivatives, aspirin, or clopidogrel, complaining of symptomatic benign prostatic hyperplasia (BPH).
Methods
We evaluated perioperative parameters, functional outcome, and adverse events up to 24 mo postoperatively of patients on OA, and compared results with 92 men at normal risk without anticoagulant therapy undergoing PVP for the same indication (control).
Results
Within 40 mo, 116 men on OA were included, with 31%(n = 36) receiving coumarin derivatives; 61%(n = 71), aspirin; and 8%(n = 9), clopidogrel. Mean prostate volume (62 ± 34 ml vs. 57 ± 25 ml; p = 0.289) and mean operation time (67 ± 28 min vs 63 ± 29 min; p = 0.313) were comparable with control. We observed no bleeding complications necessitating blood transfusions. Average postoperative decrease of haemoglobin was 8.6%for patients on OA versus 8.8%for control. At 3, 6, 12, and 24 mo postoperatively, improvement of the International Prostate Symptom Score ranged from 60–70%; postvoid residual volume, 80–88%; and average maximum urinary flow rate, 116–140%, respectively. Postoperative complications were low and comparable with control.
Conclusions
PVP is characterized by excellent haemostatic properties and very low intraoperative complication rate even in patients on OA. On the basis of our perioperative results, we recommend PVP as first-line procedure for patients with symptomatic BPH at high risk of bleeding.