A study by Westhofen (2020) et al. detailing the superiority of HoLEP over TURP in a matched-pair analysis of bleeding complications under various antithrombotic regimens.
HoLEP is considered the new gold standard for treatment of men with an enlarged prostate causing lower urinary tract issues (LUTS). There have been many studies conducted over the years that demonstrate the superiority of HoLEP to other treatment options and it's effectiveness in improving the quality of life for men who have previously suffered from Benign prostatic Hyperplasia (BPH).
Symptoms of BPH include; increased urge and frequency of urination, nocturia (night time urination), difficulty stop and starting urination, dribbling at the end of flow and the inability to completely empty your bladder.
With advances in technology over the years new techniques have been developed for prostate treatments. Dr Elmes is one of the only Urologists in Queensland who offers the newest and advanced treatment of Laser prostate surgery for an enlarged prostate. It is known as Holmium Laser Enucleation of the the Prostate - HoLEP). The treatment is proving to be effective for patients with quick procedure times, quick recovery rates, less bleeding, less blood loss, reduced catheter time, reduced hospital stays and overall post operative improved quality of life. The latest article on HoLEP by Westhofen et. al (2020) supports these key benefits of HoLEP and it's superiority over TURP.
The study is focused specifically on patients under continuous antithrombotic therapy with regard to bleeding complications and the comparisons drawn form HoLEP versus TURP. Retrospective, matched pair analysis of 221 patients with continuous antiplatelet therapy or anticoagulative medication were treated with HoLEP (111 patients) or TURP (110 patients).
The article discusses the complexities for patients with comorbidities such as cardiovascular disease and antithrombotic (blood thinning) medication takers who face challenges with their operative options as well as the higher risks associated including serious thromboembolic complications.
They evaluated functional outcomes, pre-operative morbidity and bleeding complications.
Baseline study characteristics were comparable for both HoLEP and TURP patients including:
- Median age 74 years
- BMI 26
- Pre-op PSA 2.4
- IPSS severe 22.5, QoL (quality of like) 4.1
- Post void 90ml
- Qmax 10ml/sec
- Pre-op prostate size 50cc
- Op time 60min
Post operative findings highlighted (HoLEP to be significantly more efficient than TURP)
- HoLEP median tissue retrieval 71.43%, 34grams vs. TURP 45.5%, 21grams
- Hemoglobin level (low red blood count) drop was significantly lower in HoLEP group 0.70g/dl than for TURP 2.20g/dl
- Qmax improvement HoLEP 11 ml/s vs TURP 8ml/s
- TURP it was shown that bleeding-associated complications increase significantly under concurrent anti-coagulant or anti-platelet therapy
- Bleeding-related adverse events were significantly less frequent in the HoLEP cohort 3.6% Holep vs 10.9% TURP
- Adverse events lower in HOLEP (5.4%) vs TURP (16.4%)
Reference: Westhofen T, Schott M, Keller P, Tamalunas A, Stief CG &Magistro G, 2020, 'Superiority of HoLEP over TURP in a matched-pair analysis of bleeding complications under various antithrombotic regimens', Journal of Endourology, pp1-19.