Holmium Laser Enucleation of the Prostate in Patients Requiring Anticoagulation

This is to evaluate and discuss the literature surrounding holmium laser enucleation of the prostate (HoLEP) in patients on anticoagulation.

The relationship of benign prostatic hyperplasia (BPH) to bothersome lower urinary tract symptoms (LUTS) is well established with a majority of men over the age of 60 having significant symptoms. Patients with severe enough symptoms often require surgery and with cardiovascular disease ranking as the primary cause of death in the USA, a growing number will be taking antiplatelet (AP) or anticoagulation (AC) for primary or secondary prevention of disease. A review of the recent literature focusing on patients on AP/AC undergoing HoLEP noted minimal adverse effects in the postoperative course aside from prolonged bleeding requiring catheterization with continuous bladder irrigation. Although patients with BPH and bothersome LUTS undergoing HoLEP are at a slightly greater risk for prolonged bladder irrigation secondary to bleeding, surgical outcomes are similar to men not on AP/AC. The literature surrounding newer direct oral anticoagulants (DOACs) and HoLEP is limited, and therefore, conclusions regarding continuation of DOACs cannot be drawn. However, HoLEP appears to be a safe and effective procedure for BPH-related LUTS in patients on AP/AC therapy.