Impact of antithrombotic medication on postoperative outcome of low-power HoLEP.

PURPOSE: To study the impact of antithrombotic medication on the postoperative outcome of patients undergoing low-power holmium laser enucleation of the prostate (LP-HoLEP) METHOD: Data about 432 patients operated between 2017 and 2023 in 2 centers were retrospectively analyzed. Patients were categorized based on their antithrombotic therapy into 3 groups: a control group with no antithrombotic treatment, an anticoagulated (AC) group and a group receiving platelet aggregation inhibitors (PAI). The primary objective was to compare the average duration of postoperative bladder irrigation between the three groups. A multivariate analysis was performed to identify risk factors for prolonged postoperative bladder irrigation (≥24h).

RESULTS

The group of patients on AC showed significantly longer average durations of bladder irrigation (40.79h vs 24.05h, P<0.001), bladder catheterization, and hospitalization compared to the group without antithrombotic therapy. Similarly, the rates of blood transfusion (10.1% vs 2.6%, P=0.005) and severe complications (Clavien-Dindo≥3) (30.43% vs 5.9%, P<0.001) were higher in this group. Patients on PAI had immediate postoperative outcomes comparable to those without antithrombotic therapy. At 3months postoperatively, the rate of stress urinary incontinence was higher in patients on antithrombotic therapy. In multivariate analysis, AC and prostate volume were predictive of prolonged postoperative bladder irrigation.

CONCLUSION

LP-HoLEP is an effective surgical technique for managing benign prostatic hypertrophy in patients on antithrombotic therapy. However, AC treatments, unlike PAI agents, lead to increased risk of perioperative bleeding.