Endoscopic vaporization of benign prostatic hyperplasia using a contact 980 nm diode laser under antithrombotic therapy: A prospective survey.

INTRODUCTION: To prospectively clarify whether endoscopic contact laser vaporization of the prostate (CVP) can be safely performed even in patients undergoing antithrombotic therapy. METHODS: Fifty-five patients treated with CVP were enrolled. Patients were assigned to: (i) the antithrombotic therapy group (n = 21, 38%); or (ii) control group without antithrombotic therapy (n = 34, 62%). All patients in the antithrombotic therapy group continued all antithrombotic agents during the perioperative period and thereafter. RESULTS: No difference was noted in patient background between the two groups. In primary endpoints, decreases in the postoperative hemoglobin level were remarkable in the antithrombotic therapy group, while no serious effects were noted in either group. The control and antithrombotic therapy groups did not show a significant difference in the occurrence of catheter obstruction due to blood clots or serious hematuria following catheter removal. During follow-up, transurethral coagulation for hemostasis was needed only in the antithrombotic therapy group, with a frequency of transurethral coagulation of up to 14%. In secondary endpoints, no difference in the occurrence of perioperative or late-onset complications after surgery was noted between the two groups. Finally, no difference was noted in improvements in the International Prostate Symptom Score (IPSS), IPSS quality of life score, overactive bladder symptom score, maximum flow rate, or post-voiding residual urine volume between the two groups throughout the follow-up period. CONCLUSIONS: CVP can be performed safely and effectively in patients undergoing continuous antithrombotic therapy. However, the possibility of secondary bleeding after discharge in a subset of patients, such as those undergoing antithrombotic therapy, may be noted.

Comparison of transurethral enucleation with bipolar and transurethral resection in saline for managing benign prostatic hyperplasia.

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Transurethral enucleation with bipolar (TUEB) has been widely adopted as an alternative to standard TURP, although the surgical technique, efficacy and safety of TUEB have not been described so far. The present study provides illustrations of the TUEB technique, as well as peri-operative, 6-month and 12-month follow-up results of TUEB from a retrospective review of a single-institution experience comparing the efficacy and safety of TUEB and transurethral resection in saline for managing BPH. OBJECTIVE: • To illustrate the transurethral enucleation with bipolar (TUEB) technique and compare the efficacy and safety of TUEB and transurethral resection in saline (TURis) for managing benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: • A retrospective review of a single-institution experience of 110 consecutive TUEB or TURis between 2008 and 2011 at our hospital was performed aiming to compare the efficacy and safety of TUEB and TURis for managing BPH (55 patients in each group). • Peri-operative data included operating time, resected tissue weight, changes in haemoglobin, duration of catheterization, hospital stay and early complications. • Postoperative outcomes included 6- and 12-month postoperative International Prostate Symptom Score (IPSS), and Quality of Life (QoL) score, uroflowmetry findings, change in serum prostate-specific antigen level and all late complications in the two groups. RESULTS: • Both groups were well matched for age, preoperative prostate volume, IPSS, QoL and uroflowmetry findings. • The change in haemoglobin at postoperative day 1 in the TUEB group was significantly less than in the TURis group (1.08 vs 1.60 g/dL; P < 0.001). • Catheterization time and hospital stay were significantly shorter in the TUEB group than in the TURis group and the mean retrieved tissue weight in the TUEB group was larger than that in the TURis group (41.3 vs 31.7 g; P = 0.007). • Patients in the two arms had comparable improvements in postoperative IPSS, QoL, maximum flow rate and postvoid residual urine volume. • The rates of complications were equally low with each procedure. CONCLUSION: • TUEB is superior to TURis, with less bleeding, as well as decreased catheter time and hospital stay, although showing equivalent efficacy at 12 months of follow-up.