Open Access

ARTICLE

Surgical management of BPH in patients on oral anticoagulation: transurethral bipolar plasma vaporization in saline versus transurethral monopolar resection of the prostate

Nicolas B. Delongchamps¹, Grégoire Robert², Alexandre de la Taille³, Olivier Haillot⁴, Charles Ballereau⁵, Christian Saussine⁶, François Kleinclauss⁷, Abdel-Rahmène Azzouzi⁸, Bertrand Lukacs⁹, Olivier Dumonceau¹⁰, Marc Fourmarier¹¹, Marian Devonec¹², Aurélien Descazeaud¹³

1 Hôpital Cochin, APHP, Paris Descartes University, France
2 CHU de Bordeaux Pellegrin, Bordeaux-2 Victor Segalen University, Bordeaux, France
3 CHU Henri-Mondor, APHP, Créteil, France
4 CHU de Tours, Tours, France
5 Clinique La Louvière, Lille, France
6 CHU de Strasbourg, Strasbourg, France
7 CHU de Besançon, Besançon, France
8 CHU d’Angers, Angers, France
9 Hôpital Tenon, APHP, Paris, France
10 Hôpital Saint-Joseph, Paris, France
11 CH du Pays d’Aix, Aix en Provence, France
12 CHU de Lyon Sud, Lyon, France
13 CHU de Limoges, Faculté de médecine, Limoges, France
Address correspondence to Dr. Nicolas Barry Delongchamps, Department of Urology, Cochin Hospital, 27 rue du Faubourg Saint Jacques, 75014 Paris France

Canadian Journal of Urology 2011, 18(6), 6007-6012.

Abstract

Introduction: 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).
Materials and methods: 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.
Results: 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 PAI was withdrawn preoperatively in 50 patients.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.
Conclusions: In patients on OA, TUVis led to significantly less bleeding, as well as shorter bladder catheterization and hospital stay than TURP.

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