Photoselective laser vaporization prostatectomy in men receiving anticoagulants.
OBJECTIVE
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.


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.
Sandhu
Jaspreet S
JS
Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York 10021, USA.
Ng
Casey K
CK
Gonzalez
Ricardo R
RR
Kaplan
Steven A
SA
Te
Alexis E
AE
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006400:Hematocrit; D006470:Hemorrhage; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000925:Anticoagulants