The Efficacy On Holmium Laser Enucleation Of The Prostate In Anticoagulant Patients

ObjectiveTransurethral holmium laser prostate is increasingly recognized as the standard operation for different volumes of prostatic hyperplasia in the 21 st century.Meanwhile,the efficacy and safety in elderly benign prostatic hyperplasia patients with cardiovascular diseases who need anticoagulants is nonnegligible.Therefore,the aim of this paper is to evaluate the efficacy and safety of HoLEP in benign prostatic hyperplasia patients with anticoagulants.MethodsWe retrospectively analyzed 100 BPH patients who underwent HoLEP during the October 2015 to June 2018 in the second hospital of Tianjin medical university.All patients were divided into anticoagulant group(50 cases)and non-anticoagulation group(50 cases),50 anticoagulant patients with cardiovascular diseases should be treated by discontinuous/continuous antiplatelet or antithrombotic drugs,including aspirin,clopidogrel,warfarin and low molecular heparin.All patients accorded with included and excluded criterias.Meanwhile,all patients completed preoperative routine biochemical examination,IPSS score,PSA,transrectal ultrasound examination and urine flow mechanics,for patients who were suspicious and PSA > 10 ng/ml,the pevic MRI examination was necessary in order to exclude the possibility of prostate cancer.Preoperative information about age,PSA,IPSS,preoperative blood Na + and the information such as hemoglobin(Hgb),and the size of the prostate by transrectal ultrasound results was recorded in detail.Meanwhile,intraoperative and postoperative detailed records of each patient,including surgical resection of the prostate weight,continuous flushing time,time with the urine tube,improving the value of urine flow rate,complications,postoperative blood Na + and blood Hgb decline were recorded.Moreover,all patients after surgery have for 6 months of follow-up,to compare each group patients' efficacy and safety.ResultsBy comparing the intraoperative and postoperative information of patients in the anticoagulant group and the non-anticoagulant group,the average resection weight of prostate in the anticoagulant group was 45.40 ± 22.85 g,while that in the non-anticoagulant group was 43.37 ± 19.66 g.The operation time of the anticoagulant group was 72.42 ±17.67 min,while that of the non-anticoagulant group was 68.84 ± 12.30 min.The postoperative continuous flushing time of the anticoagulant group was 20.20 ±2.78 h,and that of the non-anticoagulant group was 20.08 ±2.09 h.The catheter time of postoperative anticoagulation group was 44.16 ± 5.00 h,and that of non-anticoagulation group was 45.40 ± 4.21 h.Postoperative Hgb and serum Na+ decreased values of the anticoagulant group were 10.10 ± 6.14g/L and 0.91 ± 1.85mmol/L,while those of the non-anticoagulant group were 8.78 ± 5.98g/L and 0.18 ± 1.76mmol/L,respectively.By comparing the two groups,although patients in the anticoagulant group had a longer operation time and a greater postoperative decrease in hemoglobin,there was no statistical difference in clinical information except for the statistical difference in the serum Na+ decreased values.In addition,the follow-up and statistical analysis of complications at 6 months after surgery found that IPSS,QoL and maximum urinary flow rate were significantly improved in the two groups after 1 month,3 months and 6 months,and no serious complications such as bladder filling,thromboembolism and death occurred in the two groups after surgery.ConclusionsTransurethral holmium laser prostate enucleation in patients with anticoagulation is safe and effective.On the premise of fully assessing the patient's condition and perfecting preoperative examination,it is safe and effective for patients undergoing transurethral prostatic holmium laser enucleation with anticoagulant drugs.