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 |
