Complications and functional outcomes of high-risk patient with cardiovascular disease on antithrombotic medication treated with the 532-nm-laser photo-vaporization Greenlight XPS-180 W for benign prostate hyperplasia
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To examine the complications and functional outcomes of high-risk patients on antithrombotic therapy (ATT) treated with photoselective vaporization of the prostate (PVP) using the Greenlight (GL) XPS-180 system.
A retrospective analysis of prospectively maintained institutional database was performed. Men with symptomatic LUTS related to BPH were treated with 523-nm GL PVP using the XPS-180 W system. They were stratified according to ATT status: group 1 (control group), group 2 (acetylsalicylic acid), group 3 (antiplatelet agents other than acetylsalicylic acid) and group 4 (anticoagulation agents). Postoperative adverse events at 30- and 90-days were prospectively recorded. Complications were stratified according to the Clavien-Dindo classification. Additionally, functional outcomes (IPSS, Qmax and PVR) were analyzed up to 48 months of follow-up after surgery. Multivariable logistic regression analyses were used to predict the effect of ATT on serious bleeding-associated complications that was defined as the sum of patients with hematuria Clavien grade ≥ 2, patients requiring transfusions and patient with postoperative hemoglobin drop ≥ 15 g/dl.
274 (63%), 87 (21%), 24 (6%) and 37 (9%) patients were included in groups 1, 2, 3 and 4, respectively. Patients on antiplatelet (group 3) and anticoagulant medication (group 4) were older (median age 60 vs. 68 vs. 77 vs. 76 years, p < 0.001) and had more comorbidities (ASA 3–4: 9.5 vs. 27.6 vs. 66.7 vs. 64.9%; p < 0.001) than their counterparts. The overall 30-day complications rates were 31, 28.7, 45.8 and 45.9% of patients included in groups 1, 2, 3 and 4, respectively (p = 0.4). Hematuria Clavien 1 events (p < 0.001), readmissions rates (p = 0.02), length of post-operative hospital stay (p < 0.001) and catheterization time (p < 0.001) were significantly higher in patients on antiplatelet and anticoagulation medication. In multivariable analyses, ATT status was not a predictor of serious bleeding events after surgery (p > 0.5). Finally, functional outcomes were significantly improved accross the four groups.
GL PVP is safe and effective in treating high-risk patients on ATT. Although serious bleeding complications are rare and equivalent with non-high-risk patients, patients on antiplatelet and anticoagulation medication should be counseled on the increased risk of minor bleeding events and readmissions rates at 30 days after surgery.
KeywordsGreenlight Photoselective vaporization of the prostate Antithrombotic therapy Benign prostate hyperplasia Anticoagulation
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