Objectives
To characterize the safety and efficacy of the 180-W XPS™-Greenlight laser in patients on systemic anticoagulation.
Materials and Methods
A retrospective analysis of 384 patients who underwent photoselective vaporization (PVP) with the 180-W XPS-laser between 2010 and 2013 at two centers in the United States and Switzerland was performed. The primary outcome was the intraoperative and postoperative complication rates for those on anticoagulation undergoing PVP. The secondary outcome was IPSS scores, postvoid residual (PVR), maximum flow rate (Qmax), and prostate specific antigen levels (PSA).
Results
Of 384 patients, aspirin, clopidogrel, and warfarin were used in 146 (38%), 34 (8.9%), and 57 (14.8%) patients, respectively. Single drug, two-drug and three-drug combinations were used in 142 (35.5%), 37 (9.3%) and 7 (1.7%) of the cases. Median lasing time (39 vs. 36 min; p=0.99) and number of fibers used (1.0 vs. 1.0; p=0.63) were comparable between patients on vs. off systemic anticoagulation. Postoperatively, urinary symptoms (IPSS, QoL) and objective voiding parameters (Qmax, PVR) improved in both groups of patients. During a maximum follow-up of 2 years, patients on vs. off systemic anticoagulation did not show any significant differences in the rate of postoperative urinary tract infection (3.8% vs. 5.1%; p=0.71), retention (5.1% vs. 5.9%; p=0.71), urethral stricture (1.5% vs. none, p=0.05), and reoperation (2.2% vs. 1.5%; p=0.49). The primary limitation is the retrospective nature of the study.
Conclusions
Photovaporization of the prostate with the 180-W XPS-laser is a safe and effective minimal-invasive treatment option for patients on systemic anticoagulation.
