TY  - JOUR
A1  - Deuker, Marina
A1  - Rührup, Jessica
A1  - Karakiewicz, Pierre I.
A1  - Welte, Maria-Noemi
A1  - Kluth, Luis
A1  - Banek, Séverine
A1  - Roos, Frederik
A1  - Mandel, Philipp
A1  - Chun, Felix
A1  - Becker, Andreas
T1  - Holmium laser enucleation of the prostate: efficacy, safety and preoperative management in patients presenting with anticoagulation therapy
T2  - World journal of urology
N2  - Purpose: We evaluated efficacy and safety profile of patients with anticoagulation therapy (AT) undergoing holmium laser enucleation of the prostate (HoLEP).
Methods: Within our prospective institutional database (11/2017 to 11/2019), we analyzed functional outcomes and 30-day complication rates of HoLEP patients according to Clavien–Dindo classification (CLD), stratified according to specific AT vs. no AT. Further analyses consisted of uni- and multivariate logistic regression models (LRM) predicting complications.
Results: Of 268 patients undergoing HoLEP, 104 (38.8%) received AT: 25.7% were treated with platelet aggregation inhibitors (PAI), 8.2% with new oral anticoagulants (NOAC) and 4.9% with AT-combinations or coumarins bridged with low molecular weight heparins (LMWH/combination). Patients receiving AT were significantly more comorbid (p < 0.01). Pre- and postoperative maximal flow rates, residual void urine and IPSS at 3 months after surgery were invariably improved after HoLEP for patients with/ without AT. Overall complication rate was 19.5% in patients with no AT vs. 26.1% vs. 27.3 vs. 46.2%, respectively, in patients with PAI, NOAC and LMWH/combination (p < 0.01). Major complications (CLD ≥ 3b) occurred in 6.1% of no AT patients vs. 4.3% vs. 4.5 vs. 0% in patients with PAI, NOAC and LMWH/combination, respectively (p < 0.01). In multivariate LRM, AT was not significantly associated with higher complication rates, whereas high ASA status (OR 2.2, p = 0.04), age (OR 1.04, p = 0.02) and bioptical or incidental prostate cancer (OR 2.5, p = 0.01) represented independent risk factors.
Conclusion: Despite higher overall complication rates in AT patients, major complications were not more frequent in AT patients. HoLEP is safe and effective in anticoagulated patients.
KW  - HoLEP
KW  - Anticoagulation
KW  - Complications
KW  - Bleeding
KW  - Transfusion
KW  - Clavien–Dindo classification
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/69223
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-692235
SN  - 1433-8726
N1  - Open Access funding provided by Projekt DEAL.
N1  - Institut: Medizin
VL  - 39
IS  - 4
SP  - 1219
EP  - 1226
PB  - Springer
CY  - Berlin ; Heidelberg
ER  -