Efficacy And Safety Of Photoselective Vaporization Of The Prostate With The 180w Green Light Laser In Non-valvular Atrial Fibrillation Patients With Oral Anticoagulations Therapy

Objective:With the aging of the population,more benign prostatic hyperplasia（BPH）patients have cardiovascular and cerebrovascular diseases,and them need to take oral anticoagulations.The 532nm wavelength green laser is highly selectively absorbed by hemoglobin,leading to a better hemostatic effect.This study investigated the efficacy and safety of 180W Green Light photoselective vaporization prostatectomy（PVP）in non-valvular atrial fibrillation（NVAF）patients with taking oral Anticoagulations.Methods:To analyze 40 BPH patients with NVAF who underwent 180 W Greenlight PVP in Tianjin Union Medical Center from June 2017 to June 2019.We defined"oral anticoagulants"as vitamin K antagonists（warfarin）or direct coagulation factor Xa inhibitors（rivaroxaban,apoxaban,etc.）.In addition,40 non-atrial fibrillation BPH patients who underwent 180W Green Light PVP were included as the control group.Preoperative adjuvant examination was performed to exclude prostate malignancies and other systemic malignancies.Patients in the NVAF group were treated with"bridging"anticoagulant therapy before surgery.The operation was performed by the one experienced surgeon,and the surgeon decides to connect continuous bladder irrigation or not depending on the color of the urine.The operation time,bladder continuous flushing time,laser energy,laser luminescence time,laser energy density,postoperative catheter indwelling time and other indicators were observed.Postoperative IPSS,Qmax,PVR and perioperative complications were compared between the two groups after 6 months of follow-up.Results:Patients in the NVAF group were 63-88 years old,with an average age of72.9±6.5 years old,including 22 cases of oral warfarin patients,18 cases of oral rivaroxaban patients,9 cases of 2 points of CHA₂DS₂-VASc score,15 cases of 3points,and 16 cases of 4 points.In the control group,the age of the patients was 56-85years old,with an average age of 70.5±7.3 years old.There were 18 patients with 2points,12 patients with 3 points and 10 patients with 4 points in the CHA₂DS₂-VASc score.There were no statistically significant differences in operation time（68.2±18.8min in NVAF group and 66.2±16.9min in control group,P=0.62）,laser luminescence time（56.7±19.2min in NVAF group and 55.3±17.3min in control group,P=0.72）and laser energy（327.5±116.3Kj in NVAF group and 333.0±100.5Kj in control group,P=0.82）between the two groups.The laser energy density was lower in NVAF group than in control group（3.3±0.3KJ/g in NVAF group and 3.4±0.2KJ/g in control group,P=0.82）,but there was no statistical difference.The bladder irrigation time（1.2±1.8h in NVAF group and 0.5±1.4h in control group,P<0.05）,postoperative indwelling catheter time（5.1±0.7 days in NVAF group and 3.7±0.5 days in control group,P<0.05）and postoperative hospitalization time（5.9±0.8 days in NVAF group and 4.1±0.3 days in control group,P<0.05）of patients in the NVAF group were longer than those in the control group,and there were statistical differences.During the operation,there were no complications such as rupture of prostate capsule,severe bleeding and intraoperative conversion to TURP.Postoperative hematuria occurred in3 patients in the NVAF group,which improved after conservative treatment.In the control group,1 patient developed hematuria,which improved after conservative treatment.There was no statistical difference in IPSS scores（6.9±1.6 in NVAF group and 6.3±1.4 in control group,P=0.08）,Quality of Life scores（1.2±0.5 in NVAF group and 1.1±0.4 in control group,P=0.68）,Qmax（18.9±1.4ml/s in NVAF group and19.3±1.2ml/s in control group,P=0.17）and PVR（42.5±20.7ml in NVAF group and37.5±17.7ml in control group,P=0.25）between the two groups during follow-up.Conclusion:The BPH and NVAF patients with taking oral anticoagulations treated with 180W Green Light PVP showed no difference from the control group in terms of operation time,laser luminescence time,laser usage and laser energy density.The postoperative bladder irrigation time,postoperative indwelling catheter time and postoperative hospital stay of NVAF patients were longer than those of the control group,and the differences were statistically significant.There was no statistically difference between two groups in peroperative complications.The Qmax and PVR in two groups of patients were significantly improved than preoperative.The 180W Green Light PVP is safe and effective in BPH patients with NVAF who takingoral Vitamin K Antagonist or Coagulation Factor Xa Inhibitor.