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



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).


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.


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).


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.


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



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.


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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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