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Impact of antithrombotic medication on postoperative outcome of low-power HoLEP

Zakaria Hammoudi1, Aurélien Descazeaud1, Romain Pelette1

  • 1Urology department, CHU Limoges, Limoges, France.

The French Journal of Urology
|December 22, 2024
PubMed

Insights

Anticoagulated (AC) therapy increases bleeding risks and prolonged irrigation after low-power holmium laser enucleation of the prostate (LP-HoLEP). Platelet aggregation inhibitors (PAI) showed comparable outcomes to no antithrombotic treatment.

Area of Science:

  • Urology
  • Surgical Oncology
  • Pharmacology

Background:

  • Benign prostatic hypertrophy (BPH) management often requires surgical intervention.
  • Antithrombotic medications are frequently used in patients with cardiovascular conditions undergoing urological procedures.
  • Understanding the impact of these medications on surgical outcomes is crucial for patient safety.

Purpose of the Study:

  • To evaluate the effect of antithrombotic medications on postoperative outcomes following low-power holmium laser enucleation of the prostate (LP-HoLEP).
  • To compare the duration of postoperative bladder irrigation among patients receiving anticoagulation (AC), platelet aggregation inhibitors (PAI), or no antithrombotic therapy.
  • To identify risk factors for prolonged postoperative bladder irrigation.

Main Methods:

  • Retrospective analysis of 432 patients undergoing LP-HoLEP between 2017 and 2023.
  • Patients were stratified into three groups: no antithrombotic therapy, AC, and PAI.
  • Multivariate analysis was employed to determine predictors of prolonged irrigation (≥24h).

Main Results:

  • Patients on AC experienced significantly longer bladder irrigation (40.79h vs 24.05h), catheterization, and hospitalization.
  • Higher rates of blood transfusion (10.1% vs 2.6%) and severe complications (Clavien-Dindo≥3) (30.43% vs 5.9%) were observed in the AC group.
  • Patients on PAI demonstrated outcomes comparable to the control group; however, increased stress urinary incontinence was noted at 3 months postoperatively for all antithrombotic users.

Conclusions:

  • LP-HoLEP is an effective BPH treatment for patients on antithrombotic therapy.
  • Anticoagulated (AC) therapy is associated with increased perioperative bleeding risks compared to platelet aggregation inhibitors (PAI).
  • Prostate volume and AC therapy are significant predictors of prolonged postoperative bladder irrigation.
Abstract

Keywords:
AnticoagulantEnucleationHolmiumPowerProstate

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