Factors Influencing Intraoperative Blood Loss in Patients Undergoing Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Large Multicenter Analysis.

To assess blood loss during holmium laser enucleation of the prostate (HoLEP) and investigate the factors influencing it.

Analysis of patients with benign prostatic hyperplasia (BPH) treated with HoLEP at 3 centers. Hemoglobin and hematocrit were measured before surgery and hospital discharge. All blood transfusions performed during and after HoLEP were recorded. Blood loss outcomes were analyzed regarding antithrombotic (antiplatelet/anticoagulant) therapies and drug treatments for BPH and other conditions.

The analysis included 963 patients with a mean age of 72 years. Mean (range) prostate size was 102 (40-316) g; 28% of patients were receiving antiplatelets and 11% anticoagulants. Mean (range) prostate-specific antigen was 6.0 (0.3-43.5) ng/dL. Mean (range) operation time was 77 (28-178) minutes. Bladder calculi were found in 54 (5.6%) patients; all of them were successfully treated with cystolitholapaxy. Forty-eight (5%) patients required blood transfusion during or immediately after the HoLEP procedure. Overall, mean (SD) hemoglobin decreased from 14.6 (1.5) g/dL to 12.3 (2.1) g/dL (P <.001), and mean (SD) hematocrit decreased from 44.3% (4.7) to 37.7% (6.5) (P <.001). Neither hemoglobin nor hematocrit decreases were significantly different between patients receiving and not receiving antithrombotic therapy or BPH therapy.

HoLEP is safe and has no remarkable impact on blood loss. Patients at high risk, such as those receiving antithrombotic therapy, had the same outcome than the rest regarding blood loss, although showed a higher transfusion rate. Operating time may influence hemoglobin decrease; therefore, it should be considered in patients with higher risk of bleeding.

Urology. 2019 Jun 26 [Epub ahead of print]

Javier Romero-Otero, Lucía García-González, Borja García-Gómez, Juan Justo-Quintas, Esther García-Rojo, Daniel Antonio González-Padilla, Raquel Sopeña-Sutil, Jose Manuel Duarte-Ojeda, Alfredo Rodríguez-Antolín

Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain; Hospital Universitario Montepríncipe, Madrid, Spain; Hospital Universitario La Luz, Madrid, Spain. Electronic address: ., Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain; Hospital Universitario La Luz, Madrid, Spain., Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain; Hospital Universitario Montepríncipe, Madrid, Spain., Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain.

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