title: Laser treatment of benign prostatic hyperplasia in patients on oral anticoagulant therapy: a review.
abstract: We assessed the therapeutic efficacy and safety of laser prostatectomy (LP) for treating benign prostatic hyperplasia (BPH) in patients on oral anticoagulation. We systematically reviewed previous reports, using the Pubmed database and bibliographies of retrieved articles and reviews. The oral anticoagulation included coumarin derivatives and platelet-aggregation inhibitors (PAI). Previous studies do not allow the establishment of definitive conclusions for managing patients on oral anticoagulation and who require BPH surgery. No randomized studies are available. Nevertheless, compared to transurethral resection of the prostate (TURP), LP seems to decrease the risk of haemorrhage in patients taking PAI or coumarin derivatives. Therefore, LP is a useful alternative to TURP for managing patients on oral anticoagulation, and could be proposed as the first intention for those patients. Continuing PAI during the procedure is feasible. A replacement of coumarin derivatives by low molecular weight heparin is preferable. No conclusion can be reached on the preferred type of laser technique to treat these patients, but data on laser enucleation is much less abundant and conclusive than that on laser vaporization.
authors.affiliation: Department of Urology, CHU Limoges, Hôpital Dupuytren, Limoges, France. aurelien.descazeaud@chu-limoges.fr
authors.forename: Aurélien
authors.initials: A
authors.lastname: Descazeaud
authors.forename: Gregoire
authors.initials: G
authors.lastname: Robert
authors.forename: Abdel Rahmene
authors.initials: AR
authors.lastname: Azzousi
authors.forename: Charles
authors.initials: C
authors.lastname: Ballereau
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lukacs
authors.forename: Olivier
authors.initials: O
authors.lastname: Haillot
authors.forename: Olivier
authors.initials: O
authors.lastname: Dumonceau
authors.forename: Marian
authors.initials: M
authors.lastname: Devonec
authors.forename: Marc
authors.initials: M
authors.lastname: Fourmarier
authors.forename: Christian
authors.initials: C
authors.lastname: Saussine
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003374:Coumarins / Q000008:administration & dosage / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D003374:Coumarins; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; C030123:coumarin