title: Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation.
abstract: OBJECTIVE
  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+/-34ml vs. 57+/-25ml; p=0.289) and mean operation time (67+/-28min vs 63+/-29min; 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.
authors.affiliation: Department of Urology, University Hospital Basel, Basel, Switzerland. rruszat@uhbs.ch
authors.forename: Robin
authors.initials: R
authors.lastname: Ruszat
authors.forename: Stephen
authors.initials: S
authors.lastname: Wyler
authors.forename: Thomas
authors.initials: T
authors.lastname: Forster
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Gasser
authors.forename: Tullio
authors.initials: T
authors.lastname: Sulser
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012307:Risk Factors; D012449:Safety; D020728:Transurethral Resection of Prostate / Q000009:adverse effects
chemical_list: D000925:Anticoagulants