Management of Benign Prostatic Obstruction Using Bipolar Plasma Kinetic Energy in Coagulopathic Patients: Initial Series [2015-01-18]

ABSTRACT Introduction and Objectives: To assess feasibility, safety and efficacy of bipolar plasma kinetic energy for management of benign prostatic obstruction (BPO) in patients on anticoagulant therapy (ACT) or platelet aggregation inhibitors (PAIs). Materials and Methods: After institutional review board approval, transurethral bipolar plasma kinetic enucleation of the prostate was performed in patients presenting with BPO and on concomitant ACT or PAIs. Patient demographics and perioperative data were collected. Moreover, the type of ongoing ACT or PAIs was recorded. Patients’ Baseline and follow-up data were compared in terms of the International Prostate Symptoms Score (IPSS), peak flow rate (Qmax) and residual urine volume (PVR) at 1, 3, and 6 months using paired t-test. Results: Between December 2012 and February 2014, 30 patients underwent transurethral bipolar plasma kinetic enucleation of the prostate was included. Seven patients were on oral ACT (Warfarin) whereas 23 patients were on PAIs,including 18 on Acetyl Salicylic Acid (ASA) and 5 on Clopidogrel Bisulfate. Patients on Warfarin were shifted to low molecular weight heparin preoperatively; meanwhile Clopidogrel or ASA was continued perioperatively. The median age was 68.5 years (range: 60-80), with median prostate volume of 60cc (30-100), median PSA of 2.4 ng/ml (1-4), median preoperative hemoglobin (Hb) of 12.8 gm/dL (11-15). Five patients (16.7%) presented with preoperative indwelling urethral catheter secondary to refractory urinary retention. The mean preoperative IPSS, Qmax, and PVR were 25.4±0.6, 6.4±0.3 mL/sec, and 56.1±3.0 mL, respectively. Only one patient (3.3%) had intraoperative bleeding necessitaed blood transfusion. Two patients (6.7%) failed to void after catheter removal. No patients developed either thromboembolic complications or post transurethral resection (TUR) syndrome. Postoperative Hb was comparable to the preoperative level (12 vs. 12.8, p>0.05). Mean hospital stay and catheter time were 25.7±10.6 hours, and 16±4.1hours, respectively. IPSS, Qmax, and PVR significantly improved at all follow-up times (all p