Holmium Laser Enucleation of the Prostate in Patients Requiring Anticoagulation
Purpose of Review
This is to evaluate and discuss the literature surrounding holmium laser enucleation of the prostate (HoLEP) in patients on anticoagulation.
The relationship of benign prostatic hyperplasia (BPH) to bothersome lower urinary tract symptoms (LUTS) is well established with a majority of men over the age of 60 having significant symptoms. Patients with severe enough symptoms often require surgery and with cardiovascular disease ranking as the primary cause of death in the USA, a growing number will be taking antiplatelet (AP) or anticoagulation (AC) for primary or secondary prevention of disease. A review of the recent literature focusing on patients on AP/AC undergoing HoLEP noted minimal adverse effects in the postoperative course aside from prolonged bleeding requiring catheterization with continuous bladder irrigation.
Although patients with BPH and bothersome LUTS undergoing HoLEP are at a slightly greater risk for prolonged bladder irrigation secondary to bleeding, surgical outcomes are similar to men not on AP/AC. The literature surrounding newer direct oral anticoagulants (DOACs) and HoLEP is limited, and therefore, conclusions regarding continuation of DOACs cannot be drawn. However, HoLEP appears to be a safe and effective procedure for BPH-related LUTS in patients on AP/AC therapy.
KeywordsLower urinary tract symptoms Benign prostatic obstruction Holmium laser enucleation of the prostate (HoLEP) Anticoagulation
Lower urinary tract symptoms
Benign prostatic hyperplasia
Holmium laser enucleation of the prostate
Dual antiplatelet therapy
Acute urinary retention
direct oral anticoagulants
Coronary artery bypass grafting
American Society of Anesthesiologists
Compliance with Ethical Standards
Conflict of Interest
Marcelino Rivera declares no potential conflicts of interest.
Amy Krambeck reports personal fees from Lumenis, Boston Scientific, and Thermedx.
James Lingeman reports personal fees from Lumenis, Boston Scientific, and Beck Analytical; is an owner and medical directory of Beck Analytical; and owner and investor of Midwest Mobile Lithotripsy.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
Papers of particular interest, published recently, have been highlighted as: • Of importance
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