Superiority of Holmium Laser Enucleation of the Prostate over Transurethral Resection of the Prostate in a Matched-Pair Analysis of Bleeding Complications Under Various Antithrombotic Regimens

Westhofen, Thilo; Schott, Melanie; Keller, Patrick; Tamalunas, Alexander; Stief, Christian G. und Magistro, Giuseppe (2021): Superiority of Holmium Laser Enucleation of the Prostate over Transurethral Resection of the Prostate in a Matched-Pair Analysis of Bleeding Complications Under Various Antithrombotic Regimens. In: Journal of Endourology, Bd. 35, Nr. 3: S. 328-334

Abstract

Introduction: To compare holmium laser enucleation of the prostate (HoLEP) with transurethral resection of the prostate (TURP) in patients under continuous antithrombotic therapy with regard to bleeding complications. Materials and Methods: We conducted a retrospective matched-pair analysis of 221 patients with continuous antiplatelet therapy or anticoagulative medication, who were treated with HoLEP (n = 111) or TURP (n = 110). Matching criteria were prostate size (50 cc) and total surgical time (60 minutes). Patients were further stratified by their antithrombotic medication. We evaluated functional outcomes, perioperative morbidity, and bleeding complications according to Clavien-Dindo (CD). Results: Our perioperative assessment showed a significantly higher percentage of resected tissue for HoLEP (median 71.43%;interquartile range [IQR]: 61.82-78.57) than for TURP (median 45.45% IQR: 39.02-56.20) (p < 0.001). Total perioperative hemoglobin drop was significantly lower for the HoLEP cohort (median 0.7 g/dL;IQR: 0.3-1.1 g/dL) than for the TURP cohort (median 2.20 g/dL;IQR: 1.18-2.80 g/dL) (p < 0.001). For all subgroups, perioperative blood loss was always significantly lower for HoLEP than for TURP. The median hemoglobin drop was 0.5 g/dL vs 1.1 g/dL for the acetylsalicylic acid 100 mg (ASS) subgroup, 0.70 g/dL vs 2.95 g/dL for the ASS+ADP-receptor inhibitor subgroup, 0.65 g/dL vs 2.4 g/dL for the vitamin K antagonist subgroup, and 0.90 g/dL vs 2.70 g/dL for the direct oral anticoagulant subgroup (all, p < 0.001). Perioperative adverse events were significantly less frequent after HoLEP (5.4%) than after TURP (16.4%) (p < 0.05). Conclusion: HoLEP is an efficient and safe procedure for patients under diverse continuous antithrombotic regimens. It provides a superior perioperative hemostatic control and causes less bleeding complications in this high-risk population.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0892-7790
• Sprache: Englisch