title: Holmium Laser Enucleation of the Prostate in Patients Requiring Anticoagulation.
abstract: Holmium laser enucleation of the prostate (HoLEP) is a well-established technique for the surgical management of benign prostatic hyperplasia (BPH). A significant number of patients who require surgery for BPH are being treated with anticoagulation (AC) or antiplatelet (AP) therapy. We evaluated the efficacy and morbidity of HoLEP in this population.
  
  
  
  One hundred sixteen patients who required AC/AP therapy undergoing HoLEP from 1999 to 2014 were compared with 1558 HoLEP patients who were not on AC/AP therapy (no AC/AP). Patients on intermittent vs continuous AC/AP therapy were also compared.
  
  
  
  No significant differences in preoperative characteristics were found between patients who did and did not receive AC/AP therapy. Intraoperative characteristics were similar except for enucleation time (51 minutes vs 65 minutes, AC/AP vs no AC/AP, respectively, p < 0.001) and morcellation rate (5 g/min vs 4.5 g/min, AC/AP vs no AC/AP, respectively, p = 0.02). Postoperative outcomes were comparable in all aspects except for length of hospital stay (27.8 hours vs 24 hours, p < 0.001) and duration of continuous bladder irrigation (15 hours vs 13.5 hours, p < 0.001), both of which were longer in the AC/AP group. There was no difference between cohorts in the lowest postoperative hemoglobin or transfusion rate. Two patients (1.9%) in the AC/AP cohort required clot evacuation vs 10 patients (0.7%) in the no AC/AP cohort. Pre-, intra-, and postoperative characteristics between patients on continuous vs intermittent AC/AP were not statistically significant, except for specimen weight (55.5 g vs 74.5 g, p = 0.028), which was greater in the intermittent AC group.
  
  
  
  Other than slight prolongation of duration of bladder irrigation and hospital stay, the intermittent or continuous use of anticoagulant therapy did not adversely affect outcomes of HoLEP, suggesting that this approach is an attractive approach for such patients, especially when the prostate is extremely large.
authors.affiliation: 1 Division of Urology, Baylor Scott and White Health , Temple, Texas.
authors.forename: Marawan M
authors.initials: MM
authors.lastname: El Tayeb
authors.affiliation: 2 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Jacob
authors.affiliation: 3 Department of Urology, University of Montreal , Montreal, Canada .
authors.forename: Naeem
authors.initials: N
authors.lastname: Bhojani
authors.affiliation: 4 Methodist Research Institute , Indianapolis, Indiana.
authors.forename: Elaine
authors.initials: E
authors.lastname: Bammerlin
authors.affiliation: 2 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana.
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000378:metabolism; D006695:Holmium; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D007507:Therapeutic Irrigation; D020728:Transurethral Resection of Prostate / Q000379:methods
chemical_list: D000925:Anticoagulants; D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors; D006695:Holmium