title: Surgical management of BPH in patients on oral anticoagulation:  transurethral bipolar plasma vaporization in saline versus transurethral monopolar resection of the prostate.
abstract: BACKGROUND
  To compare postoperative outcomes of patients on oral anticoagulation (OA) treated with transurethral plasma vaporization of the prostate in saline water (TUVis) and transurethral resection of the prostate (TURP).
  
  
  METHODS
  Between January and December 2009, 111 patients on OA therapy were treated with either TURP or TUVis in eight centers.  Types of OA and perioperative management were collected.  Postoperative outcomes were statistically compared between the two groups.
  
  
  RESULTS
  A total of 57 (51%) and 54 (49%) patients were treated with TURP and TUVis, respectively.  Types of OA were not significantly different between the two groups, but bladder catheterization prior to surgery was more frequently observed in the TUVis group.  Before surgery, 28 patients were treated with warfarin alone, 74 with a platelet aggregation inhibitor (PAI) alone, and 9 with a combination of both.  PAI was withdrawn preoperatively in 50 patients.  All treatments with warfarin were switched for heparin.  Comparison of the two groups showed significantly less hemorrhagic complications after TUVis.  Patients treated with TUVis experienced less bladder washouts (2% versus 18%, p = 0.008), less late hematuria (4% versus 19%, p = 0.02), and lower decrease of serum hemoglobin (mean decrease of 0.66 versus 1.47 g/dL, p = 0.02).  Postoperative bladder catheterization and hospital stay were significantly shorter, whereas the rate of urinary retention was significantly higher.  Three months after surgery, functional results were not significantly different between the two groups.
  
  
  CONCLUSIONS
  In patients on OA, TUVis led to significantly less bleeding, as well as shorter bladder catheterization and hospital stay than TURP.
authors.affiliation: Hôpital Cochin, APHP, Paris Descartes University, France.
authors.forename: Nicolas B
authors.initials: NB
authors.lastname: Delongchamps
authors.forename: Grégoire
authors.initials: G
authors.lastname: Robert
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Olivier
authors.initials: O
authors.lastname: Haillot
authors.forename: Charles
authors.initials: C
authors.lastname: Ballereau
authors.forename: Christian
authors.initials: C
authors.lastname: Saussine
authors.forename: François
authors.initials: F
authors.lastname: Kleinclauss
authors.forename: Abdel-Rahmène
authors.initials: AR
authors.lastname: Azzouzi
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lukacs
authors.forename: Olivier
authors.initials: O
authors.lastname: Dumonceau
authors.forename: Marc
authors.initials: M
authors.lastname: Fourmarier
authors.forename: Marian
authors.initials: M
authors.lastname: Devonec
authors.forename: Aurélien
authors.initials: A
authors.lastname: Descazeaud
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy*; D005500:Follow-Up Studies; D006417:Hematuria / Q000517:prevention & control*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D014546:Urinary Catheterization; D014835:Volatilization
chemical_list: D000925:Anticoagulants