Category: BPH/LUTS: Electrosurgery, Lasers & Other Technology
Introduction & Objective : Aim of this study was to assess the complication rates in patients undergoing ThuVEP with and without ongoing antiplatelet or anticoagulation therapy.
Methods : A prospective study was performed on a consecutive series of patients who had received ThuVEP in a single institution from July 2016 to December 2017. Patients were divided into 4 groups: patients on ongoing aspirin monotherapy (n=34), patients with paused aspirin monotherapy (n=36), patients without antiplatelet/anticoagulation therapy (n=164), patients on anticoagulation therapy (bridged by low-molecular-weight heparin) (n=25).
Results : 259 patients underwent ThuVEP: 13.1% in the aspirin monotherapy group, 13.9% in the paused aspirin monotherapy group, 63.3% in the control group, and 9.7% in the anticoagulation group, respectively. Results are shown in Table 1. Patient groups were significantly different with regard to age and ASA group. Prostate volume tended to be lower in the anticoagulation group but did not pass the level of significance. During surgery, no differences were observed with regard to operative time and resected tissue. Postoperatively, the catheterization time was significantly different between the groups but not the postoperative stay. Postoperatively, blood transfusions were necessary in 1 patient (2.8%) with stopped aspirin therapy and in 2 patients (8%) on anticoagulant therapy. The 30-day total complication rate, classified according to the Clavien classification system was 5.9% in patients on aspirin monotherapy and significantly lower compared to patients on anticoagulant therapy (44%, p≤0.0004), and patients with paused aspirin monotherapy (25%, p≤0.0031), and did not differ from patients without antiplatelet/anticoagulation therapy (8.5%, p=0.4263).
Conclusions : Aspirin monotherapy did not impact the perioperative ThuVEP outcomes and should be continued during surgery. Stop of aspirin monotherapy might elevate the risk of complications in ThuVEP. Patients under oral anticoagulation bridged by low-molecular-weight heparin have a significantly elevated risk for complications compared to patients on antiplatelet treatment and controls.
Christopher Netsch– Consultant, Asklepios Klinik Barmbek, Abteilung für Urologie, Hamburg, Hamburg, Germany
Benedikt Becker– Resident, Asklepios Klinik Barmbek, Department of Urology, Hamburg, Hamburg, Germany
Andreas J. Gross– Head of Department, Asklepios Klinik Barmbek, Abteilung für Urologie, Hamburg, Hamburg, Germany
Asklepios Klinik Barmbek, Abteilung für Urologie
Hamburg, Hamburg, Germany
Dr. med. Dr. habil. Christopher Netsch, MD, FEBU is an Assistant Professor of Urology at the Semmelweis University of Budapest/Hungary. He received his medical degree from the University of Mainz/Germany. His training in urology was conducted at the Inselspital Bern/Switzerland, Städtisches Klinikum Karlsruhe/Germany and at the Asklepios Klinik Barmbek/Germany. After his board certification in 2011 (Hamburg/Germany), Dr. Netsch became a consultant urologist at the Asklepios Klinik Barmbek/Germany. Dr. Netsch completed his Endourology Fellowship at the Asklepios Klinik Barmbek in 2012. He was also qualified as a Fellow of the European Board of Urology (FEBU) in 2015.
Dr. Netsch`s research focuses on urolithiasis and minimally-invasive therapies for BPH. He has authored or co-authored over 70 peer-reviewed journal articles and numerous book chapters. He was awarded with the Mauermayer award of the German Society of Urology (DGU) in 2013 and the Hans Marberger award of the European Association of Urology (EAU) in 2014. He is currently an editorial consultant for the World Journal of Urology.
Dr. Netsch is a member of the DGU Urolithiasis Guidelines committee. He is also an active member of numerous national and international societies such as the DGU, EAU, and the Endourological Society. He is also a member of the DGU working group in Endourology and the EAU section of Uro-Technology (ESUT): Lower Tract Section.
Asklepios Klinik Barmbek, Department of Urology
Hamburg, Hamburg, Germany
Dr. Becker is a resident of urology in the urological department of the Asklepios Hospital Barmbek in Hamburg, Germany. He studied in Giessen and Lübeck (both Germany). His main scientific interest is the broad spectrum of endourology, especially laser treatment of benign prostatic obstruction. He is an active member of the German Society of Urology (DGU), the German Society of Residents in Urology (GeSRU), and the Endourological Society (WCE). At this time, he is participating in the Two Year fellowship program in Endourology/Stone Surgery.