Laser treatment of benign prostatic hyperplasia in patients on oral anticoagulant therapy: a review.
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.
Descazeaud
Aurélien
A
Department of Urology, CHU Limoges, Hôpital Dupuytren, Limoges, France. aurelien.descazeaud@chu-limoges.fr
Robert
Gregoire
G
Azzousi
Abdel Rahmene
AR
Ballereau
Charles
C
Lukacs
Bertrand
B
Haillot
Olivier
O
Dumonceau
Olivier
O
Devonec
Marian
M
Fourmarier
Marc
M
Saussine
Christian
C
de la Taille
Alexandre
A
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
D000925:Anticoagulants; D003374:Coumarins; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; C030123:coumarin