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Trends in the surgical treatment of benign prostatic hyperplasia in a tertiary hospital
Author(s) -
Ow Darren,
Papa Nathan,
Perera Marlon,
Liodakis Peter,
Sengupta Shomik,
Clarke Stephen,
Bolton Damien M.,
Lawrentschuk Nathan
Publication year - 2017
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13904
Subject(s) - medicine , perioperative , transurethral resection of the prostate , aspirin , prostate , benign prostatic hyperplasia (bph) , blood transfusion , hyperplasia , surgery , cancer
Background To assess current treatment trends and perioperative outcomes of transurethral resection of the prostate ( TURP ) and photoselective vaporization of the prostate ( PVP ) in a tertiary institution. Methods We prospectively collected a database of all patients undergoing TURP and PVP for benign prostatic hyperplasia ( BPH ) at a tertiary hospital between January 2011 and December 2013. Patient characteristics such as length of stay, readmission, anticoagulation status, American Society of Anesthesiologists ( ASA ) score and need for blood transfusion were recorded and analysed. Results In total, 560 cases were included: 204 (36.4%) underwent TURP and 356 (63.6%) PVP . Patients undergoing PVP had higher ASA scores ( P < 0.001) and were more frequently on continuing anticoagulant therapy ( P < 0.001). With regards to non‐aspirin/asasantin coagulation therapy, 61 (17.1%) patients underwent PVP with their anticoagulants continued while no patients who received TURP continued anticoagulation. Blood transfusion percentages were similar at 1.0% for TURP and 1.7% for PVP but readmission proportions were higher after PVP (32 patients, 9.0%) compared to TURP (10 patients, 4.9%). These differences were attenuated when excluding patients continuing anticoagulation during the procedure. Conclusion At our institution, the use of PVP has been increasing on a year‐by‐year basis. The results of the current study demonstrated that PVP is safe in patients with increased anaesthetic risk or on active anticoagulation when compared to traditional TURP . While this makes PVP an attractive alternative to TURP in high‐risk anticoagulated patients, these patients may have complex post‐discharge issues that should be addressed during the informed consent process.