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Holmium laser enucleation of the prostate in benign prostate hyperplasia patients with or without oral antithrombotic drugs: a meta-analysis

  • Urology - Original Paper
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Abstract

Background

The continuous intake of antithrombotic drugs during holmium laser enucleation of the prostate (HoLEP) remains nonconsensual. We aim to pool those controversial evidence and provide practical guidance of oral antithrombotics on HoLEP for benign prostate hyperplasia (BPH).

Method

PubMed, Embase and CENTRAL database were systematically searched up to June 2019 for trials on patients with and without oral antithrombotics undergoing HoLEP. Number of events and mean value with standard deviation were, respectively, extracted for dichotomous and continuous parameters. Subgroup analyses of anticoagulation and antiplatelet were also performed. All statistical analyses were conducted with Review Manager v.5.3 software. Newcastle–Ottawa Scale (NOS) was used to assess the quality of selected trials.

Result

Nine studies with 5528 patients were eventually selected, and patients included were generally older than 65 years. It revealed that the non-antithrombotic group had a lower rate of blood transfusion (OR 0.21, 95% CI 0.10–0.45, P < 0.0001), bladder tamponade (OR 0.30, 95% CI 0.13–0.69, P = 0.004) and acute urine retention (OR 0.52, 95% CI 0.30–0.89, P = 0.02). Operation time was also shorter (MD − 10.31, 95% CI − 12.76 to − 7.85, P < 0.00001) in the non-antithrombotic group, but the heterogeneity was considerable (I2 = 75%). Subgroup analyses were generally consistent with the primary analysis except the non-anticoagulation and anticoagulation group having similar operation time (MD 6.66, 95% CI − 7.15 to 20.48, P = 0.34).

Conclusion

The current study confirmed that continuous intake of antithrombotic drugs could significantly increase the risk of bleeding and blood transfusion, bladder tamponade and acute urine retention.

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Acknowledgement

This research is supported by National Natural Science Foundation of China (Grant Nos. 81702536, 81370855, 81770756), Programs from Science and Technology Department of Sichuan Province (Grant Nos. 2018HH0153 and 2017HH0063) and National key research and development program of China (Grant Nos. SQ2017YFSF090096).

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Author notes

  1. Xiaonan Zheng, Liao Peng and Dehong Cao have contributed equally to this work.

Authors and Affiliations

  1. West China Medical School, Sichuan University, Chengdu, Sichuan, People’s Republic of China

    Xiaonan Zheng & Xin Han

  2. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People’s Republic of China

    Liao Peng, Dehong Cao, Hang Xu, Lu Yang, Jianzhong Ai & Qiang Wei

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  1. Xiaonan Zheng
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Contributions

QW, JZA, LY: project designation, public funding; XNZ, XH, HX: literature search and screening; XNZ, LP, DHC: data collection; XNZ, LP, DHC: data analysis, manuscript writing/editing; All the authors read and approved the final version.

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Correspondence to Jianzhong Ai or Qiang Wei.

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Zheng, X., Peng, L., Cao, D. et al. Holmium laser enucleation of the prostate in benign prostate hyperplasia patients with or without oral antithrombotic drugs: a meta-analysis. Int Urol Nephrol 51, 2127–2136 (2019). https://doi.org/10.1007/s11255-019-02278-z

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