Delongchamps Nicolas B, Robert Grégoire, de la Taille Alexandre, Haillot Olivier, Ballereau Charles, Saussine Christian, Kleinclauss François, Azzouzi Abdel-Rahmène, Lukacs Bertrand, Dumonceau Olivier, Fourmarier Marc, Devonec Marian, Descazeaud Aurélien
Hôpital Cochin, APHP, Paris Descartes University, France.
Can J Urol. 2011 Dec;18(6):6007-12.
To compare postoperative outcomes of patients on oral anticoagulation (OA) treated with transurethral plasma vaporization of the prostate in saline water (TUVis) and transurethral resection of the prostate (TURP).
Between January and December 2009, 111 patients on OA therapy were treated with either TURP or TUVis in eight centers. Types of OA and perioperative management were collected. Postoperative outcomes were statistically compared between the two groups.
A total of 57 (51%) and 54 (49%) patients were treated with TURP and TUVis, respectively. Types of OA were not significantly different between the two groups, but bladder catheterization prior to surgery was more frequently observed in the TUVis group. Before surgery, 28 patients were treated with warfarin alone, 74 with a platelet aggregation inhibitor (PAI) alone, and 9 with a combination of both. PAI was withdrawn preoperatively in 50 patients. All treatments with warfarin were switched for heparin. Comparison of the two groups showed significantly less hemorrhagic complications after TUVis. Patients treated with TUVis experienced less bladder washouts (2% versus 18%, p = 0.008), less late hematuria (4% versus 19%, p = 0.02), and lower decrease of serum hemoglobin (mean decrease of 0.66 versus 1.47 g/dL, p = 0.02). Postoperative bladder catheterization and hospital stay were significantly shorter, whereas the rate of urinary retention was significantly higher. Three months after surgery, functional results were not significantly different between the two groups.
In patients on OA, TUVis led to significantly less bleeding, as well as shorter bladder catheterization and hospital stay than TURP.
比较接受口服抗凝治疗（OA）的患者在盐水介质中经尿道前列腺等离子体汽化术（TUVis）和经尿道前列腺切除术（TURP）后的手术效果。
2009年1月至12月期间，8个中心的111例接受OA治疗的患者接受了TURP或TUVis治疗。收集OA类型和围手术期管理情况。对两组患者的术后效果进行统计学比较。
分别有57例（51%）和54例（49%）患者接受了TURP和TUVis治疗。两组患者的OA类型无显著差异，但TUVis组术前膀胱插管更为常见。术前，28例患者单独使用华法林治疗，74例单独使用血小板聚集抑制剂（PAI），9例两者联合使用。50例患者术前停用PAI。所有使用华法林的治疗均换用肝素。两组比较显示，TUVis术后出血并发症明显较少。接受TUVis治疗的患者膀胱冲洗次数较少（2%对18%，p = 0.008），晚期血尿较少（4%对19%，p = 0.02），血清血红蛋白下降幅度较低（平均下降0.66对1.47 g/dL，p = 0.02）。术后膀胱插管时间和住院时间明显较短，而尿潴留发生率明显较高。术后三个月，两组患者的功能结果无显著差异。
对于接受OA治疗的患者，与TURP相比，TUVis导致的出血明显较少，膀胱插管时间和住院时间也较短。
