Introduction: To evaluate the short-term results of thulium vaporesection of the prostate (ThuVEP) and thulium vapoenucleation of the prostate (ThuVARP) in patients with benign prostatic obstruction on oral anticoagulants (OA). Methods: A 3-centre retrospective matched-paired comparison of patients treated by ThuVEP (n = 26) or ThuVARP (n = 26) was performed. Thirty-four patients were on aspirin/ticlopidin, 7 on clopidogrel or clopidogrel and aspirin, and 11 on phenprocoumon at the time of surgery. Results: Haemoglobin decrease was higher after ThuVEP compared to ThuVARP (1.5 vs. 0.3 g/dl, p < 0.001). The rate of postoperative blood transfusions (3.9 vs. 0%), clot retention (3.9 vs. 0%), and re-operation (7.7 vs. 0%) was not different between ThuVEP and ThuVARP (p = 0.274). Catheterization time was shorter for ThuVARP (1 vs. 2 days, p < 0.01). Qmax was significantly higher after ThuVEP at 6-month follow-up (31 vs. 21.5 ml/s, p < 0.001), while improvements in International Prostate Symptom Score, quality of life, and post-voiding residual urine showed no differences between the groups. Urethral or bladder neck strictures did not occur during the 6-month follow-up in both groups. Conclusions: ThuVEP and ThuVARP are safe and efficacious procedures in patients on OA. Although patients assigned to ThuVEP had higher Qmax at 6-month follow-up, ThuVARP resulted in similar functional outcomes.

Keywords:
Vapoenucleation , Vaporesection, Benign prostatic obstruction, ThuVEP, Anticoagulants, Tm:YAG, ThuVARP
1.
Gravas S, Bach T, Bachmann A, Drake M, Gacci M, Gratzke C, Madersbacher S, Mamoulakis C, Tikkinen KAO: European Association of Urology. Guidelines on the Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO), 2015. http://uroweb.org/wp-content/uploads/13-Non-Neurogenic-Male-LUTS_LR1.pdf.
2.
Reich O, Bachmann A, Siebels M, Hofstetter A, Stief CG, Sulser T: High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients. J Urol 2005;173:158-160.
3.
Chakravarti A, MacDermott S: Transurethral resection of the prostate in the anticoagulated patient. Br J Urol 1998;81:520-522.
4.
Dotan ZA, Mor Y, Leibovitch I, Varon D, Golomb J, Duvdevani M, Ramon J: The efficacy and safety of perioperative low molecular weight heparin substitution in patients on chronic oral anticoagulant therapy undergoing transurethral prostatectomy for bladder outlet obstruction. J Urol 2002;168:610-613; discussion 614.
5.
Taylor K, Filgate R, Guo DY, Macneil F: A retrospective study to assess the morbidity associated with transurethral prostatectomy in patients on antiplatelet or anticoagulant drugs. BJU Int 2011;108(suppl 2):45-50.
6.
Michielsen DP, Coomans D, Van Lersberghe C, Braeckman JG: Comparison of the haemostatic properties of conventional monopolar and bipolar transurethral resection of the prostate in patients on oral anticoagulants. Arch Med Sci 2011;7:858-863.
7.
Descazeaud A, Robert G, Lebdai S, Bougault A, Azzousi AR, Haillot O, Devonec M, Fourmarier M, Saussine C, Barry-Delongchamps N, de la Taille A: Impact of oral anticoagulation on morbidity of transurethral resection of the prostate. World J Urol 2011;29:211-216.
8.
Ong WL, Koh TL, Fletcher J, Gruen R, Royce P: Perioperative management of antiplatelets and anticoagulants among patients undergoing elective transurethral resection of the prostate - a single institution experience. J Endourol 2015, Epub ahead of print.
9.
Gilling PJ: Laser enucleation is increasingly becoming the standard of care for treatment of benign prostatic hyperplasia of all sizes. Eur Urol 2013;63:868-869; discussion 870-871.
10.
Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S: A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 2015;67:1066-1096.
11.
Ruszat R, Wyler S, Forster T, Reich O, Stief CG, Gasser TC, Sulser T, Bachmann A: Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol 2007;51:1031-1038; discussion 1038-1041.
12.
Sandhu JS, Ng CK, Gonzalez RR, Kaplan SA, Te AE: Photoselective laser vaporization prostatectomy in men receiving anticoagulants. J Endourol 2005;19:1196-1198.
13.
Yuan J, Wang H, Wu G, Liu H, Zhang Y, Yang L: High-power (80 W) potassium titanyl phosphate laser prostatectomy in 128 high-risk patients. Postgrad Med J 2008;84:46-49.
14.
Chung DE, Wysock JS, Lee RK, Melamed SR, Kaplan SA, Te AE: Outcomes and complications after 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia. J Urol 2011;186:977-981.
15.
Woo HH, Hossack TA: Photoselective vaporization of the prostate with the 120-W lithium triborate laser in men taking coumadin. Urology 2011;78:142-145.
16.
Sohn JH, Choi YS, Kim SJ, Cho HJ, Hong SH, Lee JY, Hwang TK, Kim SW: Effectiveness and safety of photoselective vaporization of the prostate with the 120 W HPS greenlight laser in benign prostatic hyperplasia patients taking oral anticoagulants. Korean J Urol 2011;52:178-183.
17.
Elzayat E, Habib E, Elhilali M: Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J Urol 2006;175:1428-1432.
18.
Tyson MD, Lerner LB: Safety of holmium laser enucleation of the prostate in anticoagulated patients. J Endourol 2009;23:1343-1346.
19.
Hauser S, Rogenhofer S, Ellinger J, Strunk T, Müller SC, Fechner G: Thulium laser (Revolix) vapoenucleation of the prostate is a safe procedure in patients with an increased risk of hemorrhage. Urol Int 2012;88:390-394.
20.
Macchione L, Mucciardi G, Gali' A, Di Benedetto A, Butticè S, Magno C: Efficacy and safety of prostate vaporesection using a 120-W 2-μm continuous-wave Tm:YAG laser (RevoLix 2) in patients on continuous oral anticoagulant or antiplatelet therapy. Int Urol Nephrol 2013;45:1545-1551.
21.
Netsch C, Stoehrer M, Brüning M, Gabuev A, Bach T, Herrmann TR, Gross AJ: Safety and effectiveness of thulium vapoenucleation of the prostate (ThuVEP) in patients on anticoagulant therapy. World J Urol 2014;32:165-172.
22.
Bach T, Muschter R, Sroka R, Gravas S, Skolarikos A, Herrmann TR, Bayer T, Knoll T, Abbou CC, Janetschek G, Bachmann A, Rassweiler JJ: Laser treatment of benign prostatic obstruction: basics and physical differences. Eur Urol 2012;61:317-325.
23.
Bach T, Netsch C, Haecker A, Michel MS, Herrmann TR, Gross AJ: Thulium:YAG laser enucleation (vapoenucleation) of the prostate: safety and durability during intermediate-term follow-up. World J Urol 2010;28:39-43.
24.
Szlauer R, Götschl R, Razmaria A, Paras L, Schmeller NT: Endoscopic vaporesection of the prostate using the continuous-wave 2-microm thulium laser: outcome and demonstration of the surgical technique. Eur Urol 2009;55:368-375.
25.
Bach T, Herrmann TR, Ganzer R, Burchardt M, Gross AJ: RevoLix vaporesection of the prostate: initial results of 54 patients with a 1-year follow-up. World J Urol 2007;25:257-262.
26.
Xia SJ, Zhuo J, Sun XW, Han BM, Shao Y, Zhang YN: Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur Urol 2008;53:382-389.
27.
Gilling P: Holmium laser enucleation of the prostate (HoLEP). BJU Int 2008;101:131-142.
28.
Netsch C, Tiburtius C, Bach T, Knipper S, Gross AJ: Association of prostate size and perioperative morbidity in thulium: YAG vapoenucleation of the prostate. Urol Int 2014;93:22-28.
29.
Vavassori I, Valenti S, Naspro R, Vismara A, dell'Acqua V, Manzetti A, Hurle R: Three-year outcome following holmium laser enucleation of the prostate combined with mechanical morcellation in 330 consecutive patients. Eur Urol 2008;53:599-604.
30.
Shah HN, Kausik V, Hegde S, Shah JN, Bansal MB: Evaluation of fluid absorption during holmium laser enucleation of prostate by breath ethanol technique. J Urol 2006;175:537-540.
31.
Martin AD, Nunez RN, Humphreys MR: Bleeding after holmium laser enucleation of the prostate: lessons learned the hard way. BJU Int 2011;107:433-437.
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2015
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