CHUM Department of Urology, University of Montréal, Montreal, QC, Canada.
Department of Urology, Clinique Pasteur Toulouse, Toulouse, France.
World J Urol. 2019 Aug;37(8):1671-1678. doi: 10.1007/s00345-018-2560-8. Epub 2018 Nov 26.
To examine the complications and functional outcomes of high-risk patients on antithrombotic therapy (ATT) treated with photoselective vaporization of the prostate (PVP) using the Greenlight (GL) XPS-180 system.
A retrospective analysis of prospectively maintained institutional database was performed. Men with symptomatic LUTS related to BPH were treated with 523-nm GL PVP using the XPS-180 W system. They were stratified according to ATT status: group 1 (control group), group 2 (acetylsalicylic acid), group 3 (antiplatelet agents other than acetylsalicylic acid) and group 4 (anticoagulation agents). Postoperative adverse events at 30- and 90-days were prospectively recorded. Complications were stratified according to the Clavien-Dindo classification. Additionally, functional outcomes (IPSS, Qmax and PVR) were analyzed up to 48 months of follow-up after surgery. Multivariable logistic regression analyses were used to predict the effect of ATT on serious bleeding-associated complications that was defined as the sum of patients with hematuria Clavien grade ≥ 2, patients requiring transfusions and patient with postoperative hemoglobin drop ≥ 15 g/dl.
274 (63%), 87 (21%), 24 (6%) and 37 (9%) patients were included in groups 1, 2, 3 and 4, respectively. Patients on antiplatelet (group 3) and anticoagulant medication (group 4) were older (median age 60 vs. 68 vs. 77 vs. 76 years, p < 0.001) and had more comorbidities (ASA 3-4: 9.5 vs. 27.6 vs. 66.7 vs. 64.9%; p < 0.001) than their counterparts. The overall 30-day complications rates were 31, 28.7, 45.8 and 45.9% of patients included in groups 1, 2, 3 and 4, respectively (p = 0.4). Hematuria Clavien 1 events (p < 0.001), readmissions rates (p = 0.02), length of post-operative hospital stay (p < 0.001) and catheterization time (p < 0.001) were significantly higher in patients on antiplatelet and anticoagulation medication. In multivariable analyses, ATT status was not a predictor of serious bleeding events after surgery (p > 0.5). Finally, functional outcomes were significantly improved accross the four groups.
GL PVP is safe and effective in treating high-risk patients on ATT. Although serious bleeding complications are rare and equivalent with non-high-risk patients, patients on antiplatelet and anticoagulation medication should be counseled on the increased risk of minor bleeding events and readmissions rates at 30 days after surgery.
使用 Greenlight（GL）XPS-180 系统，检查接受抗血栓治疗（ATT）的高危患者接受前列腺光选择性汽化术（PVP）的并发症和功能结果。
对前瞻性维护的机构数据库进行回顾性分析。有症状的与 BPH 相关的 LUTS 男性接受 523nm GL PVP 治疗，使用 XPS-180 W 系统。根据 ATT 状态分层：第 1 组（对照组）、第 2 组（乙酰水杨酸）、第 3 组（除乙酰水杨酸以外的抗血小板药物）和第 4 组（抗凝剂）。前瞻性记录术后 30 天和 90 天的不良事件。根据 Clavien-Dindo 分类对并发症进行分层。此外，分析了手术至术后 48 个月的功能结果（IPSS、Qmax 和 PVR）。使用多变量逻辑回归分析来预测 ATT 对严重出血相关并发症的影响，严重出血相关并发症定义为血尿 Clavien 等级≥2 的患者、需要输血的患者和术后血红蛋白下降≥15g/dl 的患者的总和。
分别有 274 例（63%）、87 例（21%）、24 例（6%）和 37 例（9%）患者纳入第 1、2、3 和 4 组。服用抗血小板药物（第 3 组）和抗凝药物（第 4 组）的患者年龄更大（中位数年龄 60 岁比 68 岁比 77 岁比 76 岁，p<0.001），合并症更多（ASA 3-4：9.5%比 27.6%比 66.7%比 64.9%；p<0.001）。分别有 31%、28.7%、45.8%和 45.9%的第 1、2、3 和 4 组患者在术后 30 天出现并发症（p=0.4）。血尿 Clavien 1 级事件（p<0.001）、再入院率（p=0.02）、术后住院时间（p<0.001）和导尿时间（p<0.001）在服用抗血小板药物和抗凝药物的患者中显著更高。多变量分析显示，ATT 状态不是术后严重出血事件的预测因素（p>0.5）。最后，四个组的功能结果均显著改善。
GL PVP 治疗 ATT 高危患者是安全有效的。尽管严重出血并发症罕见且与非高危患者相当，但服用抗血小板药物和抗凝药物的患者应告知他们在术后 30 天有轻微出血事件和再入院率增加的风险。
