TY - JOUR
T1 - To stop or not to stop. Endoscopic enucleation of the prostate in patients on blood thinners
T2 - outcomes, a real-life prospective multicenter study of 932 cases
AU - Castellani, Daniele
AU - Yuen, Steffi Kar Kei
AU - Giulioni, Carlo
AU - Fong, Khi Yung
AU - Doizi, Steeve
AU - Moretto, Stefano
AU - Zawadzki, Marek
AU - Tanidir, Yiloren
AU - Gökce, Mehmet Ilker
AU - Mahajan, Abhay
AU - Sytnik, Dmitriy
AU - Alkandari, Abdulrahman
AU - Becker, Benedikt
AU - Aydin, Cemil
AU - Akdogan, Nebil
AU - Bulut, Ender Cem
AU - More, Sumit
AU - De Coninck, Vincent
AU - Xu, Abai
AU - Gadzhiev, Nariman
AU - Malkhasyan, Vigen
AU - Tan, Karl
AU - Lim, Yong Wei
AU - Laymon, Mahmoud Nabil Ismail
AU - Mazzon, Giorgio
AU - Sarvajit, Biligere Priyadarshi
AU - Chiruvella, Mallikarjuna
AU - Enikeev, Dmitry
AU - Somani, Bhaskar
AU - AbdelAziz, Omar
AU - Herrmann, Thomas
AU - Gauhar, Vineet
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.
PY - 2025/12
Y1 - 2025/12
N2 - Purpose: To evaluate the safety of endoscopic enucleation of the prostate (EEP) in benign prostatic hyperplasia (BPH) patients maintained on blood thinners compared to those who discontinued therapy, and to identify independent predictors of postoperative bleeding complications. Methods: BPH patients on blood thinners planned for EEP were prospectively enrolled from 30 centers (December 2024-June 2025). Patients were divided into Group 1 (continued blood thinners, n = 329) and Group 2 (discontinued blood thinners, n = 603). Outcomes included bleeding complications, hospital stay, and functional results. Multivariable logistic regression identified predictors of postoperative bleeding (blood transfusion, need for restarting of continuous bladder washout, clot retention, surgical control of post-operative bleeding). Results: The overall population had a median age of 70.0 years and prostate volume of 81.0 ml. Group 1 patients had higher comorbidity rates. Group 1 demonstrated significantly longer median operative times (87.0 vs. 70.0 min, p < 0.001) and increased bleeding-related complications, including continuous bladder washout restart (14.3% vs. 2.5%, p < 0.001), blood transfusion requirements (1.5% vs. 0.5%, p < 0.001), and hospital readmissions (10.0% vs. 4.1%, p < 0.001). Rates of surgical hemostasis intervention were similar (1.8% in Group 1 vs. 2.0% in Group 2, p = 0.92). No major thrombotic events occurred. Independent predictors of bleeding included longer operative time (OR 1.01, p < 0.001) and combination antiplatelet/anticoagulant therapy (OR 2.47, p = 0.04), while tranexamic acid was associated with lower odds (OR 0.18, p < 0.001). Conclusion: EEP can be safely performed in patients on blood thinners with acceptable morbidity, though bleeding complications are higher. Combination therapy carries the highest risk, while tranexamic acid reduces bleeding complications.
AB - Purpose: To evaluate the safety of endoscopic enucleation of the prostate (EEP) in benign prostatic hyperplasia (BPH) patients maintained on blood thinners compared to those who discontinued therapy, and to identify independent predictors of postoperative bleeding complications. Methods: BPH patients on blood thinners planned for EEP were prospectively enrolled from 30 centers (December 2024-June 2025). Patients were divided into Group 1 (continued blood thinners, n = 329) and Group 2 (discontinued blood thinners, n = 603). Outcomes included bleeding complications, hospital stay, and functional results. Multivariable logistic regression identified predictors of postoperative bleeding (blood transfusion, need for restarting of continuous bladder washout, clot retention, surgical control of post-operative bleeding). Results: The overall population had a median age of 70.0 years and prostate volume of 81.0 ml. Group 1 patients had higher comorbidity rates. Group 1 demonstrated significantly longer median operative times (87.0 vs. 70.0 min, p < 0.001) and increased bleeding-related complications, including continuous bladder washout restart (14.3% vs. 2.5%, p < 0.001), blood transfusion requirements (1.5% vs. 0.5%, p < 0.001), and hospital readmissions (10.0% vs. 4.1%, p < 0.001). Rates of surgical hemostasis intervention were similar (1.8% in Group 1 vs. 2.0% in Group 2, p = 0.92). No major thrombotic events occurred. Independent predictors of bleeding included longer operative time (OR 1.01, p < 0.001) and combination antiplatelet/anticoagulant therapy (OR 2.47, p = 0.04), while tranexamic acid was associated with lower odds (OR 0.18, p < 0.001). Conclusion: EEP can be safely performed in patients on blood thinners with acceptable morbidity, though bleeding complications are higher. Combination therapy carries the highest risk, while tranexamic acid reduces bleeding complications.
KW - Anticoagulants
KW - Benign prostatic hyperplasia
KW - Endoscopic enucleation of the prostate
KW - Platelet aggregation inhibitors
UR - https://www.scopus.com/pages/publications/105021200745
U2 - 10.1007/s00345-025-06072-8
DO - 10.1007/s00345-025-06072-8
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C2 - 41206372
AN - SCOPUS:105021200745
SN - 0724-4983
VL - 43
JO - World Journal of Urology
JF - World Journal of Urology
IS - 1
M1 - 674
ER -