Photoselective vaporisation prostatectomy using a GreenLight High Performance System for patients with bleeding tendency.

OBJECTIVES To report the results of a modified vaporisation incision technique using a GreenLight High Performance System in the treatment of benign prostatic disease in men receiving anticoagulants. DESIGN Case series. SETTING Regional hospital, Hong Kong. PATIENTS From January 2007 to April 2010, 48 patients with a bleeding tendency or on oral anticoagulants who underwent photoselective vaporisation prostatectomy with a GreenLight High Performance System in the North District Hospital were studied. Data collected prospectively were analysed to determine perioperative and postoperative outcomes, including uroflowmetry parameters, serum prostate-specific antigen level, prostate volume, and complications at 1, 3, 6, and 12 months post-surgery. RESULTS The patients' mean age was 76 (standard deviation, 7; range 62-94) years. The mean follow-up period was 13 (standard deviation, 9) months. Thirty-six (75%) patients had urinary retention prior to surgery. Bleeding tendencies were due to receipt of aspirin (n=36), two antiplatelet agents (n=6), warfarin (n=4) and clopidogrel (n=1), and to thrombocytopaenia (n=1). Preoperative transrectal ultrasonography showed a mean prostate size of 58 (standard deviation, 30; range, 18-154) mL. Of the patients, 81% were discharged without a catheter and their mean hospital stay was 3 days. Five patients were readmitted for secondary haemorrhage, two had a drop of more than 10 g/L in their haemoglobin level, but only one received a blood transfusion. Mean uroflowmetry parameters, namely, peak flow rate and residual volume, were 8.7 mL/s and 199 mL preoperatively and 14.7 mL/s and 50 mL 1 year after the operation. CONCLUSION With an ageing population in which patients with various co-morbidities receive anticoagulant/antiplatelet therapy, photoselective vaporisation prostatectomy using a GreenLight High Performance System is a safe treatment option.