World Journal of Urology

, Volume 29, Issue 2, pp 211–216 | Cite as

Impact of oral anticoagulation on morbidity of transurethral resection of the prostate

  • Aurélien Descazeaud
  • Gregoire Robert
  • Souhil Lebdai
  • Alain Bougault
  • Abdel Rahmene Azzousi
  • Olivier Haillot
  • Marian Devonec
  • Marc Fourmarier
  • Christian Saussine
  • Nicolas Barry-Delongchamps
  • Alexandre de la Taille
Original Article

Abstract

Aim

To assess the impact of oral anticoagulation (OA) on morbidity of transurethral resection of the prostate (TURP). OA included warfarin and platelet aggregation inhibitors (PAI).

Patients and Method

Multicenter analysis of patients operated for symptomatic benign prostatic hyperplasia (BPH) by TURP. Patients under OA were compared to those with no OA.

Results

Out of 612 patients included in the analysis, 206 (33%) were on OA prior surgery (55 warfarin, 142 PAI, and 9 warfarin and PAI). No patient continued warfarin and clopidogrel during the operating period. Patients under OA were significantly older (75 vs. 71 yo, P < 0.001), had larger prostate volume (56 vs. 49 ml, P = 0.05), and had higher rate of bladder catheter prior surgery (26 vs. 17%, P = 0.02). At 3 months follow-up, patients in the OA group had a higher weight of resected tissue (24 vs. 21.7 g, P < 0.001), a longer duration of hospitalization (6.4 vs. 4.7 days P < 0.001), a higher rate of bladder clots (13 vs. 4.7%, P < 0.001), red cell transfusion (1.9 vs. 1.0%, P = 0.026), late hematuria (15.0 vs. 8.4%, P = 0.004), and thromboembolic events (2.4 vs. 0.7, P = 0.02). In multivariable analysis, OA status was the sole independent parameter associated with bladder clots (P = 0.004) and with late hematuria (P = 0.03).

Conclusion

OA had a significant and independent impact on TURP outcome in terms of bleeding complications. This data could be used for treatment decision and for patient’s information prior BPH surgery.

Keywords

Oral anticoagulation Warfarin Aspirin Clopidogrel BPH TURP 

Notes

Conflict of interest statement

No conflict of interest.

References

  1. 1.
    Reich O, Gratzke C, Bachmann A et al (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10, 654 patients. J Urol 180:246–249PubMedCrossRefGoogle Scholar
  2. 2.
    Borboroglu PG, Kane CJ, Ward JF, Roberts JL, Sands JP (1999) Immediate and postoperative complications of transurethral prostatectomy in the 1990 s. J Urol 162:1307–1310PubMedCrossRefGoogle Scholar
  3. 3.
    Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 50:969–979PubMedCrossRefGoogle Scholar
  4. 4.
    Kuntz RM (2007) Laser treatment of benign prostatic hyperplasia. World J Urol 25:241–247PubMedCrossRefGoogle Scholar
  5. 5.
    Barmoshe S, Zlotta AR (2006) How do I treat and follow my TUNA patients. World J Urol 24:397–404PubMedCrossRefGoogle Scholar
  6. 6.
    Herrmann TR, Gross AJ, Schultheiss D, Kaufmann PM, Jonas U, Burchardt M (2006) Transurethral microwave thermotherapy for the treatment of BPH: still a challenger? World J Urol 24:389–396PubMedCrossRefGoogle Scholar
  7. 7.
    Descazeaud A, Robert G, Azzousi AR et al (2009) Committee for lower urinary tract symptoms of the French Association of Urology. Laser treatment of benign prostatic hyperplasia in patients on oral anticoagulant therapy: a review. BJU Int 103:1162–1165PubMedCrossRefGoogle Scholar
  8. 8.
    Ruszat R, Wyler S, Forster T et al (2007) Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol 51:1031–1038PubMedCrossRefGoogle Scholar
  9. 9.
    Chakravarti A, Mawarfarinermott S (1998) Transurethral resection of the prostate in the anticoagulated patient. Br J Urol 81:520–522PubMedGoogle Scholar
  10. 10.
    Dotan ZA, Mor Y, Leibovitch I et al (2002) The efficacy and safety of perioperative low molecular weight heparin substitution in patients on chronic oral anticoagulant therapy undergoing transurethral prostatectomy for bladder outlet obstruction. J Urol 168:610–613PubMedCrossRefGoogle Scholar
  11. 11.
    Parr NJ, Loh CS, Desmond AD (1989) Transurethral resection of the prostate and bladder tumour without withdrawal of warfarin therapy. Br J Urol 64:623–625PubMedCrossRefGoogle Scholar
  12. 12.
    Burger W, Chemnitius JM, Kneissl GD, Rücker G (2005) Low-dose aspirin for secondary cardiovascular prevention—cardiovascular risks after its perioperative withdrawal vs. bleeding risks with its continuation—review and meta-analysis. J Intern Med 257:399–414PubMedCrossRefGoogle Scholar
  13. 13.
    Nielsen JD, Holm-Nielsen A, Jespersen J, Vinther CC, Settgast IW, Gram J (2000) The effect of low-dose acetylsalicylic acid on bleeding after transurethral prostatectomy—a prospective, randomized, double-blind, placebo-controlled study. Scand J Urol Nephrol 34:194–198PubMedCrossRefGoogle Scholar
  14. 14.
    Ruszat R, Wyler S, Forster T et al (2007) Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol 51:1031–1038PubMedCrossRefGoogle Scholar
  15. 15.
    Ehrlich Y, Yossepowitch O, Margel D, Lask D, Livne PM, Baniel J (2007) Early initiation of aspirin after prostate and transurethral bladder surgeries is not associated with increased incidence of postoperative bleeding: a prospective, randomized trial. J Urol 178:524–528PubMedCrossRefGoogle Scholar
  16. 16.
    Ten Cate H, Henny CP, ten Cate JW, Buller HR, Dabhoiwala NF (1987) Randomized double-blind, placebo controlled safety study of a low molecular weight heparinoid in patients under going transurethral resection of the prostate. Thromb Haemost 57:92–96PubMedGoogle Scholar
  17. 17.
    Lund L, Moller Ernst Jnsen K, Torring N, Erik Niesen J (2005) Impact of finasteride treatment on perioperative bleeding before transurethral resection of the prostate: a prospective randomized study. Scand J Urol Nephrol 39:160–162PubMedCrossRefGoogle Scholar
  18. 18.
    Ozdal OL, Ozden C, Benli K, Gokkaya S, Bulut S, Memis A (2005) Effect of short term finasteride therapy on preoperative bleeding in patients who were candidates for transurethral resection of the prostate: a randomized controlled study. Prostate cancer Prostatic dis 8:215–218PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Aurélien Descazeaud
    • 1
    • 2
    • 3
  • Gregoire Robert
    • 3
    • 4
    • 5
  • Souhil Lebdai
    • 6
  • Alain Bougault
    • 1
  • Abdel Rahmene Azzousi
    • 3
    • 6
  • Olivier Haillot
    • 3
    • 7
  • Marian Devonec
    • 3
    • 8
  • Marc Fourmarier
    • 3
    • 9
  • Christian Saussine
    • 3
    • 10
  • Nicolas Barry-Delongchamps
    • 3
    • 11
  • Alexandre de la Taille
    • 3
    • 4
    • 12
  1. 1.Department of Urology, Service de chirurgie urologiqueHopital Dupuytren CHU de LimogesLimogesFrance
  2. 2.Faculté de médecine de Limoges UA 3842Université de LimogesLimogesFrance
  3. 3.CTMH-AFUMaison de l’urologieParisFrance
  4. 4.INSERM U955 Eq07CréteilFrance
  5. 5.CHU Bordeaux, Department of UrologyUniversity Bordeaux 2 Victor SegalenBordeaux CedexFrance
  6. 6.Department of UrologyCHU AngersAngers CedexFrance
  7. 7.Department of UrologyCHU de ToursToursFrance
  8. 8.Department of UrologyCHU Lyon SudPierre‐BéniteFrance
  9. 9.Department of UrologyCHAix en ProvenceFrance
  10. 10.Department of UrologyCHU StrasbourgStrasbourgFrance
  11. 11.Department of UrologyCHU Cochin APHPParisFrance
  12. 12.Department of Urology, Assistance publique des Hopitaux de ParisCHU MondorCréteilFrance

Personalised recommendations