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Thulium Laser Vapoenucleation of the Prostate (ThuVEP) in Men at High Cardiovascular Risk and on Antithrombotic Therapy: A Single-Center Experience

1
Department of Urology, IRCCS INRCA, 60127 Ancona, Italy
2
Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, 60127 Ancona, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(4), 917; https://doi.org/10.3390/jcm9040917
Received: 28 February 2020 / Revised: 17 March 2020 / Accepted: 25 March 2020 / Published: 27 March 2020
(This article belongs to the Special Issue Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia)
Bleeding is the most common complication of transurethral resection of the prostate and simple open prostatectomy, especially in men on antiplatelet/anticoagulant therapy. The present study aimed to evaluate the safety and effectiveness of thulium laser vapoenucleation of the prostate (ThuVEP) for benign prostatic hyperplasia in patients on chronic antithrombotic medications. Between January 2015 and December 2019, 88 men underwent the procedure under antithrombotic agents in our center. The mean age was 74.7 ± 6.1 years. Median prostate volume was 66.5 mL. Patients on oral anticoagulants were bridged to low-molecular-weight heparin (n = 35). Aspirin (n = 39), clopidogrel (n = 10), and ticlopidine (n = 4) were maintained. Of the patients, 69.3% had an American Society of Anesthesiologists score ≥ 3. Blood loss at 24 h was comparable in all groups. Median catheterization length and postoperative stays were 2 and 3 days respectively. Acute cardiovascular events occurred in 2 patients (2.3%). Of the patients, 4 required prolonged bladder irrigation, 2 required blood transfusions, 1 required a cystoscopy for bleeding control, and 1 required a suprapubic cystostomy for blood clot evacuation. No patients died within 30 days of being discharged. Late complications occurred in 3 (3.8%) patients (1 optical urethrotomy and 1 bladder neck incision for stenosis; 1 acute myocardial infarction). All follow-up visits (1, 6, and 12-month) showed a significant improvement in all urinary parameters compared to baseline. ThuVEP appears to be a feasible surgical option in high-risk patients on antithrombotic regimens, with acceptable postoperative morbidity, good functional outcome, and low incidence of medium-term reoperation rate. View Full-Text
Keywords: aging; anticoagulants; benign prostatic hyperplasia; intraoperative complications; laser therapy; platelet aggregation inhibitors; postoperative complications; prostatectomy; ThuVEP aging; anticoagulants; benign prostatic hyperplasia; intraoperative complications; laser therapy; platelet aggregation inhibitors; postoperative complications; prostatectomy; ThuVEP
MDPI and ACS Style

Castellani, D.; Di Rosa, M.; Gasparri, L.; Pucci, M.; Dellabella, M. Thulium Laser Vapoenucleation of the Prostate (ThuVEP) in Men at High Cardiovascular Risk and on Antithrombotic Therapy: A Single-Center Experience. J. Clin. Med. 2020, 9, 917. https://doi.org/10.3390/jcm9040917

AMA Style

Castellani D, Di Rosa M, Gasparri L, Pucci M, Dellabella M. Thulium Laser Vapoenucleation of the Prostate (ThuVEP) in Men at High Cardiovascular Risk and on Antithrombotic Therapy: A Single-Center Experience. Journal of Clinical Medicine. 2020; 9(4):917. https://doi.org/10.3390/jcm9040917

Chicago/Turabian Style

Castellani, Daniele; Di Rosa, Mirko; Gasparri, Luca; Pucci, Michele; Dellabella, Marco. 2020. "Thulium Laser Vapoenucleation of the Prostate (ThuVEP) in Men at High Cardiovascular Risk and on Antithrombotic Therapy: A Single-Center Experience" J. Clin. Med. 9, no. 4: 917. https://doi.org/10.3390/jcm9040917

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