Rivera Marcelino, Krambeck Amy, Lingeman James
Indiana University School of Medicine, 1801 Senate Blvd. Suite 220, Indianapolis, IN, 46202, USA.
Curr Urol Rep. 2017 Oct;18(10):77. doi: 10.1007/s11934-017-0727-2.
This is to evaluate and discuss the literature surrounding holmium laser enucleation of the prostate (HoLEP) in patients on anticoagulation.
The relationship of benign prostatic hyperplasia (BPH) to bothersome lower urinary tract symptoms (LUTS) is well established with a majority of men over the age of 60 having significant symptoms. Patients with severe enough symptoms often require surgery and with cardiovascular disease ranking as the primary cause of death in the USA, a growing number will be taking antiplatelet (AP) or anticoagulation (AC) for primary or secondary prevention of disease. A review of the recent literature focusing on patients on AP/AC undergoing HoLEP noted minimal adverse effects in the postoperative course aside from prolonged bleeding requiring catheterization with continuous bladder irrigation. Although patients with BPH and bothersome LUTS undergoing HoLEP are at a slightly greater risk for prolonged bladder irrigation secondary to bleeding, surgical outcomes are similar to men not on AP/AC. The literature surrounding newer direct oral anticoagulants (DOACs) and HoLEP is limited, and therefore, conclusions regarding continuation of DOACs cannot be drawn. However, HoLEP appears to be a safe and effective procedure for BPH-related LUTS in patients on AP/AC therapy.
评估并讨论有关接受抗凝治疗的患者行钬激光前列腺剜除术(HoLEP)的相关文献。
良性前列腺增生(BPH)与令人困扰的下尿路症状(LUTS)之间的关系已得到充分确立,大多数60岁以上男性有明显症状。症状严重到一定程度的患者通常需要手术,在美国,心血管疾病是主要死因,越来越多的患者将服用抗血小板药物(AP)或抗凝药物(AC)用于疾病的一级或二级预防。一篇针对接受HoLEP治疗的AP/AC患者的近期文献综述指出,术后过程中除了因出血需要持续膀胱冲洗并留置导尿管导致出血时间延长外,不良反应极少。尽管患有BPH且有令人困扰的LUTS的患者因出血导致膀胱冲洗时间延长的风险略高,但手术结果与未服用AP/AC的男性相似。关于新型直接口服抗凝剂(DOACs)与HoLEP的文献有限,因此,无法得出关于继续使用DOACs的结论。然而,对于接受AP/AC治疗的患者,HoLEP似乎是治疗与BPH相关的LUTS的一种安全有效的手术。