Efficacy and Safety of Photoselective Vaporization of the Prostate with 120 W 532 nm Laser in Patients with Benign Prostatic Hyperplasia on Anticoagulation or Antiplatelet Therapy: Observations on Long-Term Outcomes

Benign prostatic hyperplasia wound after surgical removal in subjects on anticoagulant or antiplatelet therapy: A meta-analysis

We performed a meta-analysis to evaluate the safety of benign prostatic hyperplasia wound after surgical removal in subjects on anticoagulant or antiplatelet therapy. A systematic literature search up to December 2021 was done and 19 studies included 5715 benign prostatic hyperplasia subjects at the start of the study; 1501 of them were on anticoagulant/antiplatelet therapy, and 4214 were control. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the safety of benign prostatic hyperplasia wound after surgical removal in subjects on anticoagulant or antiplatelet therapy by the dichotomous or continuous methods with a random or fixed-influence model. Anticoagulant/antiplatelet therapy had significantly higher bleeding complication (OR, 1.88; 95% CI, 1.36-2.60, P < .001), higher blood transfusion (OR, 2.15; 95% CI, 1.63-2.83, P < .001), lower operation time (MD, -3.53; 95% CI, -6.80-0.27, P = .03), higher catheterization time (MD, 0.30 95% CI, 0.06-0.53, P = .01), longer length of hospital stay (MD, 0.82; 95% CI, 0.37-1.26, P < .001) and higher thromboembolic events (OR, 2.88; 95% CI, 1.26-6.62, P = .01) compared to control in benign prostatic hyperplasia subjects. Anticoagulant/antiplatelet therapy had a significantly higher bleeding complication, higher blood transfusion, lower operation time, higher catheterization time, longer length of hospital stay and higher thromboembolic events compared to control in benign prostatic hyperplasia subjects. Further studies are required.

GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database

PURPOSE

We sought to characterize the adjusted outcomes of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients using data from the largest international database.

METHODS

Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. Eligible study participants underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume.

RESULTS

In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p < 0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4-2.8, p < 0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+ 0.54 (95% CI 0.07-1.0, p = 0.02)]. PVR also decreased 93.1 ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6-152.6, p < 0.01).

CONCLUSION

We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease compared to their lower-risk counterparts. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.

Efficacy and Safety of 1470-nm Diode Laser Enucleation of the Prostate in Individuals With Benign Prostatic Hyperplasia Continuously Administered Oral Anticoagulants or Antiplatelet Drugs

OBJECTIVE

To evaluate the efficacy and safety of 1470-nm Diode Laser Enucleation of the Prostate (DiLEP) in patients with benign prostatic hyperplasia continuously receiving oral anticoagulants or antiplatelet drugs.

METHODS

From January 2016 to June 2017, 144 patients were submitted to 1470-nm DiLEP, including 49 (34.0%) continuously administered anticoagulants or antiplatelet drugs per os due to cardiac and/or cerebrovascular diseases (group A), while 95 (66.0%) were not (group B). Evaluation was performed preoperatively, and at postoperative 3, 6, and 12 months, respectively. Patient baseline features, operative data, perioperative complications, and postsurgical outcomes were assessed.

RESULTS

Both groups had comparable preoperative parameters, except age (77.3 ± 7.5 vs 73.2 ± 8.8 years, P = .007). Meanwhile, surgical time, sodium decrease, catheterization duration, and hospital stay markedly differed between the 2 groups. In comparison with group B, group A patients had statistically higher blood loss (14.9 ± 7.3 g/L vs 10.2 ± 7.0 g/L, P < .001) and increased bladder irrigation time (21.1 ± 10.9 hours vs 16.1 ± 9.0 hours, P = .004). One case required blood transfusion in group A, because of moderate anemia preoperatively. Both groups showed similar blood transfusion and complication rates. International Prostate Symptom Score, quality of life score, maximum flow rate, and postvoid residual were markedly improved in both groups at 3-, 6-, and 12-month follow-up postoperatively compared with baseline values. However, no statistically significant differences were observed between the 2 groups in various assessment parameters at follow-up (P > .05).

CONCLUSION

These findings demonstrated that 1470-nm DiLEP is efficient and safe in benign prostatic hyperplasia cases receiving continuous oral anticoagulant or antiplatelet drugs. Anticoagulation therapy did not significantly influence the results and complication rates.

Device Malfunctions and Complications Associated with Benign Prostatic Hyperplasia Surgery: Review of the Manufacturer and User Facility Device Experience Database

Introduction and Objectives: Multiple surgical therapies for benign prostatic hyperplasia (BPH) have been developed to decrease complications and increase provider efficiency. We investigated contemporary BPH treatment device-related adverse events by searching a publicly available database. Materials and Methods: The Manufacturer and User Facility Device Experience (MAUDE) database was queried for contemporary BPH treatments. All devices were evaluated for malfunction, patient complications, and manufacturer review. The MAUDE adverse event classification system was used to standardize complications. Univariate analysis was performed to identify associations between BPH devices and adverse events. Results: A total of 2567 reports were identified: transurethral resection of the prostate (TURP) 197 (7.67%), holmium laser enucleation of the prostate (HoLEP) 39 (1.52%), GreenLight™ 2315 (90.2%), and UroLift^® 16 (0.62%). The most common deviations for each modality included cutting loop detachment during TURP 116 (58.9%), morcellator dysfunction for HoLEP 23 (58.9%), tip fracture/detachment for GreenLight (68.8%), and failure to deploy during UroLift 10 (62.5%). Only 18 (0.7%) patients required medical/surgical management (MAUDE II-IV) due to a device complication. No significant relationship was seen between each modality and complications; however, morcellator use (27.8%) was observed in higher grade complications. Manufacturer review occurred in 61.7% of cases, with 41.3% of reviewed cases finding the operator the cause of the malfunction. Conclusion: Each BPH modality investigated had minimal patient harm with over 99% of patients experiencing no complication after device malfunction. Of note, great care should be taken with morcellator use during HoLEP as it had the greatest number of MAUDE II to IV complications among all devices. Manufacturer review revealed that over 40% of cases were due to misuse by the user. Therefore, urologists should select the modalities they are most familiar with to decrease patient harm and prevent device malfunctions.

Photoselective vaporization has comparative efficacy and safety among high-risk benign prostate hyperplasia patients on or off systematic anticoagulation: a meta-analysis

PURPOSE

The necessity to cease anticoagulation before photoselective vaporization (PVP) surgery remains nonconsensual. We aimed at assessing the efficacy and safety of PVP among high-risk benign prostate hyperplasia (BPH) patients on or off anticoagulation.

METHODS

We systematically searched Pubmed, Embase, and Cochrane Library Central Register of Controlled Trials (CENTRAL). 2299 patients from 11 studies were eventually included. Newcastle-Ottawa Scale (NOS) was employed to assess the quality and risk of bias of each study. All statistical analyses were conducted with Review Manager v.5.3 software.

RESULTS

Ten parameters (operation time, laser time, blood transfusion, urethral stricture, urinary tract infection, reoperation, dysuria, capsule perforation, catheterization time, and re-catheterization) from patients on or off anticoagulant therapy were collected. The patients without anticoagulants performed better at catheterization time [MD - 0.54, 95% CI (- 0.82, - 0.26), P = 0.96, I² = 0] with a reduction of 0.54 day than those on anticoagulants. Significant statistical difference was not observed from other parameters. Subgroup analysis, grouped by the power output of PVP systems (80 W, 120 W and 180 W), consistently showed no statistical significant difference except at catheterization time in the 180-W PVP subgroup.

CONCLUSION

PVP, a safe and effective option for high-risk BPH patients, work comparably regardless of anticoagulant therapy, despite non-anticoagulant patients have shorter catheterization time. It is implied that the use of anticoagulants might be unnecessary to stop for high-risk BPH patients undergoing PVP for the sake of safety, which certainly requires further investigations to confirm.