title: Risk factors for delayed hematuria following photoselective vaporization of the prostate.
abstract: OBJECTIVE
  Photoselective vaporization of the prostate has become an increasingly popular option for the treatment of benign prostatic hyperplasia. However, delayed bleeding has been raised as a potential issue as more cases are performed. We characterize delayed bleeding after photoselective vaporization of the prostate and identify associated risk factors.
  
  
  METHODS
  We defined delayed gross hematuria as any complaint of hematuria following hospital discharge, and further stratified it as delayed gross hematuria requiring emergency department evaluation, hospital admission, continuous bladder irrigation, transfusions or reoperation. We performed an explicit chart review of 290 patients who underwent photoselective vaporization of the prostate at a single center from 2002 through 2009. Exposures of interest included age, prostate volume, followup duration, operative factors (watts/joules), and use of oral anticoagulation therapy or 5α-reductase inhibitors.
  
  
  RESULTS
  Delayed gross hematuria occurred in 33.8% of patients during an average followup of 33 months. For 8.5% of patients the bleeding was severe enough to prompt presentation to the emergency department. For 4.8% of patients hospitalization was required and for 4.5% reoperation was required. Multivariate analysis revealed that the odds of bleeding increased with prostate size (OR 1.08, 1.03-1.14), longer followup (OR 1.35, 1.12-1.62) and anticoagulant use (OR 3.35, 1.43-7.83), and decreased with increasing age (OR 0.71, 0.51-0.98) and use of a 5α-reductase inhibitor (OR 0.41, 0.24-0.73).
  
  
  CONCLUSIONS
  Delayed hematuria occurs commonly after photoselective vaporization of the prostate but severe hematuria is rare. Larger prostate size, longer followup and use of anticoagulation were associated with a higher risk of delayed gross hematuria while preoperative 5α-reductase inhibitor use and older age were protective.
authors.affiliation: Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Jackson
authors.forename: Nina F
authors.initials: NF
authors.lastname: Casanova
authors.forename: Lauren P
authors.initials: LP
authors.lastname: Wallner
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Hedgepeth
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Faerber
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D005500:Follow-Up Studies; D006417:Hematuria / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000379:methods; D016896:Treatment Outcome
keywords: 5ARI; 5α-reductase inhibitor; CBI; DH; ED; ER; PVP; TRUS; TURP; anticoagulants; continuous bladder irrigation; delayed gross hematuria; emergency department; emergency room; lasers; photoselective vaporization of the prostate; prostate; prostatic hyperplasia; transrectal ultrasound; transurethral resection of the prostate; urination disorders