CLINICAL COURSE OF PATIENTS RECEIVING ANTI-PLATELETS THERAPY WHO

UNDERWENT THULIUM LASER ENUCLEATION OF THE PROSTATE.

Carmignani, Bozzini, Ratti, Picozzi, Casellato, Macchi, Finkelberg, Osmolorskiy°,

Kamalov°

Academic Dep. Of Urology, University of Milan, Policlinico San Donato

°Urology Department, Lomonosov Moscow State University

INTRODUCTION: With the progressive ageing of the population, the prevalence of

vascular disease as the prevalence of benign prostatic enlargement is increasing. In
recent years, laser prostatectomy is emerging as a replacement for the standard
transurethral resection of prostate (TURP). The aim of this study was to evaluate the
clinical course of patients receiving anti-platelets therapy who underwent Thulium Laser
Enucleation of the Prostate.

MATERIALS AND METHODS: A cooperation between the University of Milan and Moscow
was settled. From September 2011 we start a prospective study on patients who
underwent ThuLEP. All candidates for surgical therapy of lower urinary tract symptoms
(LUTS) and obstruction due to a BPH. This work evaluated the surgical outcomes of 42
ThuLEP in patients taking anti-platelet therapy to 50 procedures performed in patients who
have never taken anti-platelet agents before surgery.

RESULTS: The study group included 39 patients who had been on anti-platelet
monotherapy with ASA 100 – 300 mg and 3 in Ticlopidine. In the study group 37
procedures (88%) were performed under spinal anaesthesia, while 5 were performed
under general anaesthesia. There was not a significant difference in operative time. A
comparison test between groups was not statistically significant with regards to the
decrease in hemoglobin concentration. Transfusional support was required in one
procedures performed in patients taking anti-platelet therapy, and in no procedures in
controls. There were no adverse cardiac events (myocardial infarction, angina,
cardiovascular failure, hypovolemic shock). One patient in the treatment group required re-
intervention to ensure hemostasis. During this period one case of haematuria happens two
week in every of the two group that was treated conservatively. No further bleeding or
cardiac events were recorded.

CONCLUSION: In this study we demonstrated for the first time that patients undergoing
ThuLEP, who continued taking anti-platelet agents had no a significantly increased
incidence of perioperative bleeding-associated morbidity compared with those who were
not taking any anti-platelet medication.