NEW YORK (Reuters Health) - Holmium laser enucleation of the prostate (HoLEP) is a safe and effective treatment for symptomatic BPH in men receiving anticoagulant therapy, Canadian researchers report.

Transurethral resection of the prostate (TURP) is the gold standard for treating symptomatic BPH. However, it is often avoided in men on anticoagulant therapy out of concern for the bleeding risks. HoLEP is considered an alternative to TURP that may reduce the risk of bleeding complications.

As reported in the Journal of Urology for April, Dr. Mostafa Elhilali and colleagues, from McGill University in Montreal, assessed the outcomes of 81 patients on anticoagulant therapy and 2 patients with hemophilia who underwent HoLEP for symptomatic BPH refractory to medical therapy. The subjects were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively.

Fourteen patients underwent HoLEP with continued anticoagulant therapy. The remaining patients were nearly evenly split between HoLEP with low molecular weight heparin substitution or with preoperative anticoagulant discontinuation, the report indicates.

HoLEP was successfully performed in all men (mean enucleation time= 86.5 minutes) and was associated with significant improvements in peak urinary flow, post-void residual urine, International Prostate Symptom Score and quality of life.

Intraoperative platelet transfusion was required in one patient and postoperative blood transfusion was needed in seven. Hemoglobin levels fell significantly from a mean value of 13.5 mg/dL before HoLEP to 12.2 mg/dL afterward. No thromboembolic events or other major complications occurred in any patient.

"The excellent hemostatic properties of the holmium laser allow HoLEP to be a safer and effective alternative to conventional treatment in patients on anticoagulant therapy or with bleeding disorders with a lower incidence of bleeding requiring blood transfusion," the researchers state.

J Urol 2006;175:1428-1432

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