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Holmium laser enucleation of the prostate in benign prostate hyperplasia patients with or without oral antithrombotic drugs: a meta-analysis

  • Xiaonan Zheng
  • Liao Peng
  • Dehong Cao
  • Xin Han
  • Hang Xu
  • Lu Yang
  • Jianzhong AiEmail author
  • Qiang WeiEmail author
Urology - Original Paper
  • 52 Downloads

Abstract

Background

The continuous intake of antithrombotic drugs during holmium laser enucleation of the prostate (HoLEP) remains nonconsensual. We aim to pool those controversial evidence and provide practical guidance of oral antithrombotics on HoLEP for benign prostate hyperplasia (BPH).

Method

PubMed, Embase and CENTRAL database were systematically searched up to June 2019 for trials on patients with and without oral antithrombotics undergoing HoLEP. Number of events and mean value with standard deviation were, respectively, extracted for dichotomous and continuous parameters. Subgroup analyses of anticoagulation and antiplatelet were also performed. All statistical analyses were conducted with Review Manager v.5.3 software. Newcastle–Ottawa Scale (NOS) was used to assess the quality of selected trials.

Result

Nine studies with 5528 patients were eventually selected, and patients included were generally older than 65 years. It revealed that the non-antithrombotic group had a lower rate of blood transfusion (OR 0.21, 95% CI 0.10–0.45, P < 0.0001), bladder tamponade (OR 0.30, 95% CI 0.13–0.69, P = 0.004) and acute urine retention (OR 0.52, 95% CI 0.30–0.89, P = 0.02). Operation time was also shorter (MD − 10.31, 95% CI − 12.76 to − 7.85, P < 0.00001) in the non-antithrombotic group, but the heterogeneity was considerable (I2 = 75%). Subgroup analyses were generally consistent with the primary analysis except the non-anticoagulation and anticoagulation group having similar operation time (MD 6.66, 95% CI − 7.15 to 20.48, P = 0.34).

Conclusion

The current study confirmed that continuous intake of antithrombotic drugs could significantly increase the risk of bleeding and blood transfusion, bladder tamponade and acute urine retention.

Keywords

Benign prostate hyperplasia (BPH) Holmium laser enucleation of the prostate (HoLEP) Antithrombotic Perioperative safety 

Notes

Acknowledgement

This research is supported by National Natural Science Foundation of China (Grant Nos. 81702536, 81370855, 81770756), Programs from Science and Technology Department of Sichuan Province (Grant Nos. 2018HH0153 and 2017HH0063) and National key research and development program of China (Grant Nos. SQ2017YFSF090096).

Authors’ contributions

QW, JZA, LY: project designation, public funding; XNZ, XH, HX: literature search and screening; XNZ, LP, DHC: data collection; XNZ, LP, DHC: data analysis, manuscript writing/editing; All the authors read and approved the final version.

Compliance with the ethical standard

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Not applicable as there are no study participants.

Research involving human participants and/or animals

Not applicable as there are no human participants and/or animals.

References

  1. 1.
    Wei JT, Calhoun E, Jacobsen SJ (2005) Urologic diseases in America project: benign prostatic hyperplasia. J Urol 173(4):1256–1261.  https://doi.org/10.1097/01.ju.0000155709.37840.fe CrossRefGoogle Scholar
  2. 2.
    Roehrborn CG (2005) Benign prostatic hyperplasia: an overview. Rev Urol 7(Suppl 9):S3–s14Google Scholar
  3. 3.
    Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, Oelke M, Tikkinen KAO, Gravas S (2015) EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67(6):1099–1109.  https://doi.org/10.1016/j.eururo.2014.12.038 CrossRefGoogle Scholar
  4. 4.
    EAU Guidelines. Edn. presented at the EAU Annual Congress Barcelona 2019. ISBN 978-94-92671-04-2Google Scholar
  5. 5.
    Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol 50(5):969–979.  https://doi.org/10.1016/j.eururo.2005.12.042 (discussion 980) CrossRefGoogle Scholar
  6. 6.
    Mebust WK, Holtgrewe HL, Cockett AT, Peters PC (2002) Transurethral prostatectomy: immediate and postoperative complications: a cooperative study of 13 participating institutions evaluating 3,885 patients 1989. J Urol 167(2 Pt 2):999–1003 (discussion 1004) CrossRefGoogle Scholar
  7. 7.
    Gilling PJ, Kennett K, Das AK, Thompson D, Fraundorfer MR (1998) Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol 12(5):457–459.  https://doi.org/10.1089/end.1998.12.457 CrossRefGoogle Scholar
  8. 8.
    Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R, Cestari A, Briganti A, Mazzoccoli B, Rigatti P, Montorsi F (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates > 70 g: 24-month follow-up. Eur Urol 50(3):563–568.  https://doi.org/10.1016/j.eururo.2006.04.003 CrossRefGoogle Scholar
  9. 9.
    Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096.  https://doi.org/10.1016/j.eururo.2014.06.017 CrossRefGoogle Scholar
  10. 10.
    Krambeck AE, Handa SE, Lingeman JE (2013) Experience with more than 1000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 189(1 Suppl):S141–S145.  https://doi.org/10.1016/j.juro.2012.11.027 Google Scholar
  11. 11.
    Kuntz RM, Ahyai S, Lehrich K, Fayad A (2004) Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol 172(3):1012–1016.  https://doi.org/10.1097/01.ju.0000136218.11998.9e CrossRefGoogle Scholar
  12. 12.
    Kosmidou I, Liu Y, Alu MC, Liu M, Madhavan M, Chakravarty T, Makkar R, Thourani VH, Biviano A, Kodali S, Leon MB (2019) Antithrombotic therapy and cardiovascular outcomes after transcatheter aortic valve replacement in patients with atrial fibrillation. JACC Cardiovasc Interv 12(16):1580–1589.  https://doi.org/10.1016/j.jcin.2019.06.001 CrossRefGoogle Scholar
  13. 13.
    Oh-Oka H, Gotoh A, Hanioka K, Okada H (1998) Leiomyoma of the urinary bladder causing tamponade. Scand J Urol Nephrol 32(6):420–421CrossRefGoogle Scholar
  14. 14.
    Golabek T, Powroznik J, Szostek P, Chlosta P, Borowka A (2013) Percutaneous suprapubic endoscopy for treatment of bladder tamponade. Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other mini-invasive techniques 8 (4):364–365. https://doi.org/10.5114/wiitm.2011.35637Google Scholar
  15. 15.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13.  https://doi.org/10.1186/1471-2288-5-13 CrossRefGoogle Scholar
  16. 16.
    Boeri L, Capogrosso P, Ventimiglia E, Fontana M, Sampogna G, Zanetti SP, Pozzi E, Zuabi R, Schifano N, Chierigo F, Longo F, Gadda F, Dell’Orto PG, Scattoni V, Montorsi F, Montanari E, Salonia A (2019) Clinical comparison of holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate in patients under either anticoagulation or antiplatelet therapy. Eur Urol Focus.  https://doi.org/10.1016/j.euf.2019.03.002 Google Scholar
  17. 17.
    Becker B, Netsch C, Hansen J, Bohme A, Gross AJ, Zacharias M, Lehrich K (2019) Perioperative safety in patient under oral anticoagulation during holmium laser enucleation of the prostate. J Endourol 33(3):219–224.  https://doi.org/10.1089/end.2018.0693 CrossRefGoogle Scholar
  18. 18.
    El Tayeb MM, Jacob JM, Bhojani N, Bammerlin E, Lingeman JE (2016) Holmium laser enucleation of the prostate in patients requiring anticoagulation. J Endourol 30(7):805–809.  https://doi.org/10.1089/end.2016.0070 CrossRefGoogle Scholar
  19. 19.
    Tyson MD, Lerner LB (2009) Safety of holmium laser enucleation of the prostate in anticoagulated patients. J Endourol 23(8):1343–1346.  https://doi.org/10.1089/end.2009.0013 CrossRefGoogle Scholar
  20. 20.
    Sun J, Shi A, Tong Z, Xue W (2018) Safety and feasibility study of holmium laser enucleation of the prostate (HOLEP) on patients receiving dual antiplatelet therapy (DAPT). World J Urol 36(2):271–276.  https://doi.org/10.1007/s00345-017-2129-y CrossRefGoogle Scholar
  21. 21.
    Elzayat E, Habib E, Elhilali M (2006) Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J Urol 175(4):1428–1432.  https://doi.org/10.1016/s0022-5347(05)00645-2 CrossRefGoogle Scholar
  22. 22.
    Bishop CV, Liddell H, Ischia J, Paul E, Appu S, Frydenberg M, Pham T (2013) Holmium laser enucleation of the prostate: comparison of immediate postoperative outcomes in patients with and without antithrombotic therapy. Curr Urol 7(1):28–33.  https://doi.org/10.1159/000343549 CrossRefGoogle Scholar
  23. 23.
    Neuville P, Codas R, Ravier E, Maucort-Boulch D, Badet L, Fassi-Fehri H (2018) Anticoagulation impact on bleeding risk during HoLEP: monocentric study of 156 patients. Progres en urologie: journal de l’Association francaise d’urologie et de la Societe francaise d’urologie 28(2):128–134.  https://doi.org/10.1016/j.purol.2017.10.013 CrossRefGoogle Scholar
  24. 24.
    Matuoka T, Suzuki I, Suzuki R, Fukunaga A, Dohi Y, Sugino Y, Inoue K, Kawakita M (2017) Clinical study of HoLEP for the patients with benign prostatic hyperplasia who are on oral antithrombotics. World J Urol 63(8):307–311.  https://doi.org/10.14989/ActaUrolJap_63_8_307 Google Scholar
  25. 25.
    Descazeaud A, Robert G, Lebdai S, Bougault A, Azzousi AR, Haillot O, Devonec M, Fourmarier M, Saussine C, Barry-Delongchamps N, de la Taille A (2011) Impact of oral anticoagulation on morbidity of transurethral resection of the prostate. World J Urol 29(2):211–216.  https://doi.org/10.1007/s00345-010-0561-3 CrossRefGoogle Scholar
  26. 26.
    Taylor K, Filgate R, Guo DY, Macneil F (2011) A retrospective study to assess the morbidity associated with transurethral prostatectomy in patients on antiplatelet or anticoagulant drugs. BJU Int 108(Suppl 2):45–50.  https://doi.org/10.1111/j.1464-410X.2011.10686.x CrossRefGoogle Scholar
  27. 27.
    Zheng X, Qiu Y, Qiu S, Tang L, Nong K, Han X, Li M, Quan L, Yang L, Wei Q (2019) Photoselective vaporization has comparative efficacy and safety among high-risk benign prostate hyperplasia patients on or off systematic anticoagulation: a meta-analysis. World J Urol 37(7):1377–1387.  https://doi.org/10.1007/s00345-018-2530-1 CrossRefGoogle Scholar
  28. 28.
    Michielsen DP, Coomans D, Van Lersberghe C, Braeckman JG (2011) Comparison of the haemostatic properties of conventional monopolar and bipolar transurethral resection of the prostate in patients on oral anticoagulants. World J Urol 7(5):858–863.  https://doi.org/10.5114/aoms.2011.25562 Google Scholar
  29. 29.
    Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N’Dow J, Nordling J, de la Rosette JJ (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64(1):118–140.  https://doi.org/10.1016/j.eururo.2013.03.004 CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.West China Medical SchoolSichuan UniversityChengduPeople’s Republic of China
  2. 2.Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduPeople’s Republic of China

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