[Benign prostatic hyperplasia surgery and anticoagulant therapy: review of the literature by the French Association of Urology].
BACKGROUND
The prescription of a long-term oral anticoagulant may pose several problems for the endoscopic surgery of benign prostatic hyperplasia (BPH). Questions regarding the length of its interruption, what it can be replaced by and the date oral treatment can be resumed must be asked at preoperative stage to avoid haemorrhaging or cardiovascular accidents. While the number of patients concerned by this type of prescription continues to grow, surgical hemostasis techniques continue to progress and recommendations for good practice are evolving. It is therefore interesting to bring up to date the knowledge and recommendations for surgery of BHP while being treated with anticoagulants.


METHODS
A systematic revue of publications and of recommendations by knowledgeable bodies in cardiology and anesthesia were carried out.


RESULTS
The transurethral resection of the prostate (TURP) is an intervention which carries an intermediate risk of haemorrhaging. Whenever possible, it is recommended to briefly interrupt the anticoagulant treatment in the perioperative period. For antivitamins K, heparinotherapy takes over, which, thanks to a short half-life, allows for a quicker management of the anticoagulation. For antiplatelets, the tendency is towards proposing an interruption for 4 to 5 days before the intervention. In all cases, the anticoagulant must be reintroduced as quickly as possible because cardiovascular risks are in proportion to the length of time of interruption.


CONCLUSIONS
The strategy for treatment of patients taking oral anticoagulants is complex. It must be defined in consultation with the anesthetist, the cardiologist or hemostatis specialist. Nevertheless, the urologist remains at the center of the decision for treatment because he/she is the only one who can weigh up the risk of haemorrhaging, the cardiovascular risks and the necessity of an operation and technique used.
Robert
G
G
Département d'urologie, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France. gregoire.robert@chu-bordeaux.fr
Descazeaud
A
A
Azzouzi
A R
AR
Saussine
C
C
Haillot
O
O
Dumonceau
O
O
Ballereau
C
C
Fourmarier
M
M
Devonec
M
M
Lukacs
B
B
Desgrandchamps
F
F
de la Taille
A
A
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011470:Prostatic Hyperplasia / Q000601:surgery*; D020728:Transurethral Resection of Prostate
D000925:Anticoagulants