title: Outcomes and complications after 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia.
abstract: OBJECTIVE
  Patients on anticoagulation are at high risk for bleeding after electrocautery transurethral resection of the prostate or open prostatectomy and they are often denied surgery for symptomatic benign prostatic hyperplasia. Using photoselective vaporization of the prostate, patients at high risk may safely undergo surgery. We explored outcomes and complications after photoselective vaporization of the prostate in an anticoagulated, high risk cohort.
  
  
  METHODS
  Between 2002 and 2008, 162 men on systemic anticoagulation underwent photoselective vaporization of the prostate. Data were collected on demographics, comorbidities, complications, serum sodium, hematocrit, maximum flow rate, post-void residual urine, International Prostate Symptom Score and complications.
  
  
  RESULTS
  Mean±SD age was 72±8 years, mean baseline prostate volume was 91±49 gm and mean prostate specific antigen was 4.1±5 ng/ml. Of the patients 31 (19%) were on warfarin, 101 (62%) were on acetylsalicylic acid, 19 (12%) were on clopidogrel and 11 (7%) were on 2 or more anticoagulants. Median American Society of Anesthesiologists class was 3 and mean Charlson comorbidity index was 5. Median operative time was 105 minutes and mean energy use was 280±168 kJ. The immediate mean hematocrit decrease was 1.94%±2.42%. One patient who received excessive intravenous fluids experienced heart failure. Complications within 30 days included urinary tract infection in 4 patients (2.5%) and delayed bleeding in 6 (4%). Three of these patients (50%) required blood transfusion and 1 (17%) required reoperation. In 2 years of followup 3 patients (2%) required repeat photoselective vaporization of the prostate. No incontinence or urethral stricture developed. Significant improvements occurred in International Prostate Symptom Score, maximum flow rate and post-void residual urine.
  
  
  CONCLUSIONS
  Results support using 532 nm photoselective vaporization of the prostate in patients at high risk on systemic anticoagulation, even those on 2 or more anticoagulation agents and with a large prostate requiring longer operative time. Few complications developed and significant durable clinical improvement was seen.
authors.affiliation: Section of Urology, University of Chicago and Department of Surgery, Mount Sinai Hospital, Chicago, Illinois 60608, USA. doreen_chung@yahoo.ca
authors.forename: Doreen E
authors.initials: DE
authors.lastname: Chung
authors.forename: James S
authors.initials: JS
authors.lastname: Wysock
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
authors.forename: Scott R
authors.initials: SR
authors.lastname: Melamed
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kaplan
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Te
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants