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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The safety and efficacy of aspirin intake in photoselective vaporization laser
treatment of benign prostate hyperplasia</title><author><name sortKey="Shao, I Hung" sort="Shao, I Hung" uniqKey="Shao I" first="I-Hung" last="Shao">I-Hung Shao</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author><author><name sortKey="Hou, Chen Pang" sort="Hou, Chen Pang" uniqKey="Hou C" first="Chen-Pang" last="Hou">Chen-Pang Hou</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author><author><name sortKey="Chen, Shao Ming" sort="Chen, Shao Ming" uniqKey="Chen S" first="Shao-Ming" last="Chen">Shao-Ming Chen</name><affiliation><nlm:aff id="af3-cia-8-265">Department of Urology, Taipei City Hospital, Heping Campus, Taipei, Taiwan, People’s Republic of China</nlm:aff></affiliation></author><author><name sortKey="Chen, Chien Lun" sort="Chen, Chien Lun" uniqKey="Chen C" first="Chien-Lun" last="Chen">Chien-Lun Chen</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation><affiliation><nlm:aff id="af2-cia-8-265">Bioinformation Center, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author><author><name sortKey="Lin, Yu Hsiang" sort="Lin, Yu Hsiang" uniqKey="Lin Y" first="Yu-Hsiang" last="Lin">Yu-Hsiang Lin</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author><author><name sortKey="Chang, Phei Lang" sort="Chang, Phei Lang" uniqKey="Chang P" first="Phei-Lang" last="Chang">Phei-Lang Chang</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation><affiliation><nlm:aff id="af2-cia-8-265">Bioinformation Center, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author><author><name sortKey="Tsui, Ke Hung" sort="Tsui, Ke Hung" uniqKey="Tsui K" first="Ke-Hung" last="Tsui">Ke-Hung Tsui</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation><affiliation><nlm:aff id="af2-cia-8-265">Bioinformation Center, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23662050</idno><idno type="pmc">3646392</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646392</idno><idno type="RBID">PMC:3646392</idno><idno type="doi">10.2147/CIA.S41270</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000360</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000360</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The safety and efficacy of aspirin intake in photoselective vaporization laser
treatment of benign prostate hyperplasia</title><author><name sortKey="Shao, I Hung" sort="Shao, I Hung" uniqKey="Shao I" first="I-Hung" last="Shao">I-Hung Shao</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author><author><name sortKey="Hou, Chen Pang" sort="Hou, Chen Pang" uniqKey="Hou C" first="Chen-Pang" last="Hou">Chen-Pang Hou</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author><author><name sortKey="Chen, Shao Ming" sort="Chen, Shao Ming" uniqKey="Chen S" first="Shao-Ming" last="Chen">Shao-Ming Chen</name><affiliation><nlm:aff id="af3-cia-8-265">Department of Urology, Taipei City Hospital, Heping Campus, Taipei, Taiwan, People’s Republic of China</nlm:aff></affiliation></author><author><name sortKey="Chen, Chien Lun" sort="Chen, Chien Lun" uniqKey="Chen C" first="Chien-Lun" last="Chen">Chien-Lun Chen</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation><affiliation><nlm:aff id="af2-cia-8-265">Bioinformation Center, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author><author><name sortKey="Lin, Yu Hsiang" sort="Lin, Yu Hsiang" uniqKey="Lin Y" first="Yu-Hsiang" last="Lin">Yu-Hsiang Lin</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author><author><name sortKey="Chang, Phei Lang" sort="Chang, Phei Lang" uniqKey="Chang P" first="Phei-Lang" last="Chang">Phei-Lang Chang</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation><affiliation><nlm:aff id="af2-cia-8-265">Bioinformation Center, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author><author><name sortKey="Tsui, Ke Hung" sort="Tsui, Ke Hung" uniqKey="Tsui K" first="Ke-Hung" last="Tsui">Ke-Hung Tsui</name><affiliation><nlm:aff id="af1-cia-8-265">Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation><affiliation><nlm:aff id="af2-cia-8-265">Bioinformation Center, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</nlm:aff></affiliation></author></analytic><series><title level="j">Clinical Interventions in Aging</title><idno type="ISSN">1176-9092</idno><idno type="eISSN">1178-1998</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Endoscopic surgical treatment has become an option to treat benign prostate hyperplasia. We
evaluated the safety and effectiveness of photoselective vaporization of the prostate (PVP) in
patients. We evaluated preoperative and perioperative parameters, functional outcomes, and adverse
events up to 12 months postoperatively of patients on oral anticoagulation therapy undergoing PVP,
and compared the results with patients who did not take anticoagulation therapy. A total of 89
patients who received photoselective vaporization laser for benign prostate hyperplasia from May
2006 to February 2011 in our hospital were enrolled in our study. The patients were divided into two
groups based on whether or not they were taking oral aspirin; 23 (25.8%) patients were
taking aspirin derivatives (aspirin group), and 66 (74.2%) were not taking aspirin
derivatives (control group). The mean prostate volume (58.8 mL vs 51 mL; <italic>P</italic>= 0.16) and mean energy consumption (235,268 J vs 289,793 J; <italic>P</italic> =
0.097) were comparable between the aspirin group and control group. The average postoperative
results of hemoglobin were 13.4 mg/ dL for the aspirin group versus 13.9 mg/dL for the control group
(<italic>P</italic> = 0.327). A significantly higher maximum flow rates and 80%
improved post-void residual urine were noted during the followup. Postoperatively all variable
showed significant improvement starting at month 1 of followup and remained improved for the 12
month followup. Postoperative complications were low and comparable between groups. PVP was
characterized by excellent hemostatic properties and a very low intraoperative complication rate,
even in the patients who were taking aspirin. On the basis of our perioperative results, we
recommend PVP as a safe and effective procedure for patients with symptomatic benign prostate
hyperplasia when taking an aspirin derivative.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Rassweiler, J" uniqKey="Rassweiler J">J Rassweiler</name></author><author><name sortKey="Teber, D" uniqKey="Teber D">D Teber</name></author><author><name sortKey="Kuntz, R" uniqKey="Kuntz R">R Kuntz</name></author><author><name sortKey="Hofmann, R" uniqKey="Hofmann R">R Hofmann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yu, X" uniqKey="Yu X">X Yu</name></author><author><name sortKey="Elliott, Sp" uniqKey="Elliott S">SP Elliott</name></author><author><name sortKey="Wilt, Tj" uniqKey="Wilt T">TJ Wilt</name></author><author><name sortKey="Mcbean, Am" uniqKey="Mcbean A">AM McBean</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Miano, R" uniqKey="Miano R">R Miano</name></author><author><name sortKey="De Nunzio, C" uniqKey="De Nunzio C">C De Nunzio</name></author><author><name sortKey="Asimakopoulos, Ad" uniqKey="Asimakopoulos A">AD Asimakopoulos</name></author><author><name sortKey="Germani, S" uniqKey="Germani S">S Germani</name></author><author><name sortKey="Tubaro, A" uniqKey="Tubaro A">A Tubaro</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mebust, Wk" uniqKey="Mebust W">WK Mebust</name></author><author><name sortKey="Holtgrewe, Hl" uniqKey="Holtgrewe H">HL Holtgrewe</name></author><author><name sortKey="Cockett, At" uniqKey="Cockett A">AT Cockett</name></author><author><name sortKey="Peters, Pc" uniqKey="Peters P">PC Peters</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Milam, Df" uniqKey="Milam D">DF Milam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reich, O" uniqKey="Reich O">O Reich</name></author><author><name sortKey="Bachmann, A" uniqKey="Bachmann A">A Bachmann</name></author><author><name sortKey="Schneede, P" uniqKey="Schneede P">P Schneede</name></author><author><name sortKey="Zaak, D" uniqKey="Zaak D">D Zaak</name></author><author><name sortKey="Sulser, T" uniqKey="Sulser T">T Sulser</name></author><author><name sortKey="Hofstetter, A" uniqKey="Hofstetter A">A Hofstetter</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lewis, Hd" uniqKey="Lewis H">HD Lewis</name></author><author><name sortKey="Davis, Jw" uniqKey="Davis J">JW Davis</name></author><author><name sortKey="Archibald, Dg" uniqKey="Archibald D">DG Archibald</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cipollone, F" uniqKey="Cipollone F">F Cipollone</name></author><author><name sortKey="Rocca, B" uniqKey="Rocca B">B Rocca</name></author><author><name sortKey="Patrono, C" uniqKey="Patrono C">C Patrono</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weiss, Hj" uniqKey="Weiss H">HJ Weiss</name></author><author><name sortKey="Aledort, Lm" uniqKey="Aledort L">LM Aledort</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bach, T" uniqKey="Bach T">T Bach</name></author><author><name sortKey="Huck, N" uniqKey="Huck N">N Huck</name></author><author><name sortKey="Wezel, F" uniqKey="Wezel F">F Wezel</name></author><author><name sortKey="H Cker, A" uniqKey="H Cker A">A Häcker</name></author><author><name sortKey="Gross, Aj" uniqKey="Gross A">AJ Gross</name></author><author><name sortKey="Michel, Ms" uniqKey="Michel M">MS Michel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seitz, M" uniqKey="Seitz M">M Seitz</name></author><author><name sortKey="Bayer, T" uniqKey="Bayer T">T Bayer</name></author><author><name sortKey="Ruszat, R" uniqKey="Ruszat R">R Ruszat</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Malek, Rs" uniqKey="Malek R">RS Malek</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kang, Hw" uniqKey="Kang H">HW Kang</name></author><author><name sortKey="Jebens, D" uniqKey="Jebens D">D Jebens</name></author><author><name sortKey="Malek, Rs" uniqKey="Malek R">RS Malek</name></author><author><name sortKey="Mitchell, G" uniqKey="Mitchell G">G Mitchell</name></author><author><name sortKey="Koullick, E" uniqKey="Koullick E">E Koullick</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hillmen, P" uniqKey="Hillmen P">P Hillmen</name></author><author><name sortKey="Young, Ns" uniqKey="Young N">NS Young</name></author><author><name sortKey="Schubert, J" uniqKey="Schubert J">J Schubert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Patrono, C" uniqKey="Patrono C">C Patrono</name></author><author><name sortKey="Coller, B" uniqKey="Coller B">B Coller</name></author><author><name sortKey="Dalen, Je" uniqKey="Dalen J">JE Dalen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sohn, Jh" uniqKey="Sohn J">JH Sohn</name></author><author><name sortKey="Choi, Ys" uniqKey="Choi Y">YS Choi</name></author><author><name sortKey="Kim, Sj" uniqKey="Kim S">SJ Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chung, De" uniqKey="Chung D">DE Chung</name></author><author><name sortKey="Wysock, Js" uniqKey="Wysock J">JS Wysock</name></author><author><name sortKey="Lee, Rk" uniqKey="Lee R">RK Lee</name></author><author><name sortKey="Melamed, Sr" uniqKey="Melamed S">SR Melamed</name></author><author><name sortKey="Kaplan, Sa" uniqKey="Kaplan S">SA Kaplan</name></author><author><name sortKey="Te, Ae" uniqKey="Te A">AE Te</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Interv Aging</journal-id><journal-id journal-id-type="iso-abbrev">Clin Interv Aging</journal-id><journal-title-group><journal-title>Clinical Interventions in Aging</journal-title></journal-title-group><issn pub-type="ppub">1176-9092</issn><issn pub-type="epub">1178-1998</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23662050</article-id><article-id pub-id-type="pmc">3646392</article-id><article-id pub-id-type="doi">10.2147/CIA.S41270</article-id><article-id pub-id-type="publisher-id">cia-8-265</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>The safety and efficacy of aspirin intake in photoselective vaporization laser
treatment of benign prostate hyperplasia</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Shao</surname><given-names>I-Hung</given-names></name><xref ref-type="aff" rid="af1-cia-8-265"><sup>1</sup></xref><xref ref-type="author-notes" rid="fn1-cia-8-265"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hou</surname><given-names>Chen-Pang</given-names></name><xref ref-type="aff" rid="af1-cia-8-265"><sup>1</sup></xref><xref ref-type="author-notes" rid="fn1-cia-8-265"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chen</surname><given-names>Shao-Ming</given-names></name><xref ref-type="aff" rid="af3-cia-8-265"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chen</surname><given-names>Chien-Lun</given-names></name><xref ref-type="aff" rid="af1-cia-8-265"><sup>1</sup></xref><xref ref-type="aff" rid="af2-cia-8-265"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lin</surname><given-names>Yu-Hsiang</given-names></name><xref ref-type="aff" rid="af1-cia-8-265"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chang</surname><given-names>Phei-Lang</given-names></name><xref ref-type="aff" rid="af1-cia-8-265"><sup>1</sup></xref><xref ref-type="aff" rid="af2-cia-8-265"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tsui</surname><given-names>Ke-Hung</given-names></name><xref ref-type="corresp" rid="c1-cia-8-265"></xref><xref ref-type="aff" rid="af1-cia-8-265"><sup>1</sup></xref><xref ref-type="aff" rid="af2-cia-8-265"><sup>2</sup></xref></contrib></contrib-group><aff id="af1-cia-8-265"><label>1</label>Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</aff><aff id="af2-cia-8-265"><label>2</label>Bioinformation Center, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine</aff><aff id="af3-cia-8-265"><label>3</label>Department of Urology, Taipei City Hospital, Heping Campus, Taipei, Taiwan, People’s Republic of China</aff><author-notes><fn id="fn1-cia-8-265" fn-type="equal"><label>*</label><p>These authors contributed equally to this work</p></fn><corresp id="c1-cia-8-265">Correspondence: Ke-Hung Tsui, Chang Gung Memorial Hospital, Department of
Urology, Fu-shing Street, Gueishan, Taoyuan 333, Taiwan, People’s Republic of China, Tel
+886 2 2735 9577, Fax +886 2 735 8775, Email
<email>khtsui@yahoo.com</email></corresp></author-notes><pub-date pub-type="collection"><year>2013</year></pub-date><pmc-comment>Dove Press titles changed from ppub to collections in 2009.
Fake ppub written to satisfy Coll Date Type=ppub</pmc-comment>
<pub-date pub-type="ppub"><year>2013</year></pub-date><pub-date pub-type="epub"><day>09</day><month>3</month><year>2013</year></pub-date><volume>8</volume><fpage>265</fpage><lpage>269</lpage><history><date date-type="received"><day>08</day><month>3</month><year>2013</year></date></history><permissions><copyright-statement>© 2013 Shao et al, publisher and licensee Dove Medical Press
Ltd</copyright-statement><copyright-year>2013</copyright-year><license><license-p>This is an Open Access article which permits unrestricted noncommercial use, provided the
original work is properly cited.</license-p></license></permissions><abstract><p>Endoscopic surgical treatment has become an option to treat benign prostate hyperplasia. We
evaluated the safety and effectiveness of photoselective vaporization of the prostate (PVP) in
patients. We evaluated preoperative and perioperative parameters, functional outcomes, and adverse
events up to 12 months postoperatively of patients on oral anticoagulation therapy undergoing PVP,
and compared the results with patients who did not take anticoagulation therapy. A total of 89
patients who received photoselective vaporization laser for benign prostate hyperplasia from May
2006 to February 2011 in our hospital were enrolled in our study. The patients were divided into two
groups based on whether or not they were taking oral aspirin; 23 (25.8%) patients were
taking aspirin derivatives (aspirin group), and 66 (74.2%) were not taking aspirin
derivatives (control group). The mean prostate volume (58.8 mL vs 51 mL; <italic>P</italic>= 0.16) and mean energy consumption (235,268 J vs 289,793 J; <italic>P</italic> =
0.097) were comparable between the aspirin group and control group. The average postoperative
results of hemoglobin were 13.4 mg/ dL for the aspirin group versus 13.9 mg/dL for the control group
(<italic>P</italic> = 0.327). A significantly higher maximum flow rates and 80%
improved post-void residual urine were noted during the followup. Postoperatively all variable
showed significant improvement starting at month 1 of followup and remained improved for the 12
month followup. Postoperative complications were low and comparable between groups. PVP was
characterized by excellent hemostatic properties and a very low intraoperative complication rate,
even in the patients who were taking aspirin. On the basis of our perioperative results, we
recommend PVP as a safe and effective procedure for patients with symptomatic benign prostate
hyperplasia when taking an aspirin derivative.</p></abstract><kwd-group><kwd>prostate gland</kwd><kwd>benign prostatic hyperplasia</kwd><kwd>laser</kwd><kwd>elderly</kwd><kwd>green light laser</kwd></kwd-group></article-meta></front><body><sec><title>Introduction</title><p>Endoscopic surgery is one of the treatment options for patients with benign prostate hyperplasia
(BPH). Transurethral resection of the prostate (TURP) and open prostatectomy are considered the gold
standard,<xref ref-type="bibr" rid="b1-cia-8-265">1</xref>–<xref ref-type="bibr" rid="b3-cia-8-265">3</xref> however, both procedures are associated with the risk of mortality and
morbidity. TURP may lead to intraoperative bleeding, and transurethral resection syndrome occurs in
2% of all patients.<xref ref-type="bibr" rid="b4-cia-8-265">4</xref> On the other hand, open
surgery for high-volume glands is associated with morbidity.<xref ref-type="bibr" rid="b3-cia-8-265">3</xref> A great deal of research has been undertaken to reduce the complications and mortality,
and as a result several laser-based minimally invasive treatment options have been introduced,
including photoselective vaporization of the prostate (PVP).</p><p>During the last decade, there has been a continuous decline in the number of TURP procedures
performed. In 1999, TURP accounted for 81% of all surgeries for benign prostatic hypertrophy
in the USA.<xref ref-type="bibr" rid="b2-cia-8-265">2</xref> However, by 2005, the rate had fallen
to 39% due to the combined effect of fewer prostatic operations and a greater number of
minimally invasive procedures.<xref ref-type="bibr" rid="b2-cia-8-265">2</xref> Among the different
laser systems, the GreenLight HPS<sup>®</sup> laser system (American Medical Systems, Inc,
Minnetonka, MN, USA) is one of the most commonly used to treat BPH. For a better coagulation effect
with photoselective vaporization, most patients can undergo the surgery without altering their
anticoagulant medication regimen.<xref ref-type="bibr" rid="b5-cia-8-265">5</xref>,<xref ref-type="bibr" rid="b6-cia-8-265">6</xref> If the patients are taking an aspirin derivative during
PVP therapy, the amount of hemoglobin absorption will be increased, thereby increasing the
effectiveness of total laser energy consumption. We hypothesized that taking aspirin would increase
the prostate gland blood flow and make it easier to receive PVP.</p><p>Since the standard GreenLight laser system emits a 532 nm laser beam which is mainly absorbed by
oxyhemoglobin, a higher performance system was introduced to treat larger prostates to increase the
efficiency of vaporization. However, data are lacking on GreenLight vaporization rates for patients
who are taking aspirin. Therefore, we investigated the safety and efficacy of whether the
prescription of anticoagulant aspirin influenced energy consumption when vaporizing prostate tissue
with a GreenLight laser system.</p></sec><sec sec-type="materials|methods"><title>Materials and methods</title><p>The study population was comprised of a total of 89 patients who received PVP with the GreenLight
HPS<sup>®</sup> laser system (American Medical Systems, Inc) and a side firing ADD
Stat™ laser fiber with a 600 mm core diameter. In most instances the GreenLight HPS laser
procedure was begun using a power of only 60 W. The power setting was increased to 100 W and then to
120 W after tissue became more resistant to vaporization. The PVP laser procedure for BPH from May
2006 to February 2011 at our hospital was included retrospectively. Informed consent was obtained
from each patient. Their medical charts were reviewed for data including age, aspirin prescription,
prostate volume, preoperative blood sample (hemoglobin, prothrombin time [PT],
activated partial thromboplastin time [APTT], and platelet count), and preoperative
and postoperative uroflow data. The mean prostate size was 53 cc, with a serum prostate specific
antigen level of 7.15 ng/mL (ranging from 0.30–38.6 ng/mL).The exclusion criteria included
patients who had prostate cancer, urethral stricture or neurogenic bladder either diagnosed before
or after the operation, previously received any form of prostate procedure, any other coagulopathy
disease, and those who regularly took other oral coagulants.</p><p>All laser prostatectomy procedures were performed with a GreenLight laser system. We calculated
the energy consumption per prostate volume as follows: energy consumption per prostate volume
(J/mL<sup>3</sup>) = total energy consumption (J)/total prostate volume (mL<sup>3</sup>).
The patients were divided into two groups based on whether or not they were taking oral aspirin. The
patients who were taking aspirin 100 mg/day were informed to take it throughout the procedure
without interruption. The total energy consumption and lasing time during the operation were also
recorded for each patient and compared between the two groups.</p><p>All statistical analyses were performed using SPSS version 17.0 (IBM Corporation, Armonk, NY,
USA) to compare the results among the groups concerning aspirin takers and non-aspirin takers. Since
the data were not normally distributed, nonparametric tests (Kruskal–Wallis and
Mann–Whitney) were applied.</p></sec><sec sec-type="results"><title>Results</title><p>A total of 89 patients who underwent PVP with the Green-Light laser system were included. Among
these patients, 23 (the aspirin group) had been regularly taking aspirin with a dose of 100 mg per
day for prophylaxis of heart disease. All 23 patients kept taking aspirin throughout the surgery.
The other 66 patients (the control group) had not been regularly taking aspirin or any other
anticoagulants. The average age of all of the patients was 72 years. None of the patients had
received transrectal echo guide prostate needle biopsy before surgery. The preoperative parameters
including hemoglobin, PT, APTT, platelet count, and International Prostate Symptom Score (IPSS) are
listed in <xref ref-type="table" rid="t1-cia-8-265">Table 1</xref>. The operative data, including
lasing time, total energy consumption, and energy consumption per prostate volume, are also listed
in <xref ref-type="table" rid="t1-cia-8-265">Table 1</xref>.</p><p>All of the parameters were compared with an independent <italic>t</italic>-test,
Kruskal–Wallis test, or Mann–Whitney test. There were no significant differences in
preoperative parameters including age, prostate volume, serum prostate-specific antigen level,
hemoglobin, PT, APTT, platelet count, and IPSS between the aspirin and control groups (<xref ref-type="table" rid="t1-cia-8-265">Table 1</xref>).</p><p>The mean total energy consumption in the control group was higher than that in the aspirin group,
although the difference did not reach statistical significance (289,793 J versus 235,268 J;
<italic>P</italic> = 0.097). The energy consumption per prostate volume in the aspirin group
was 4297 J/mL<sup>3</sup>, which was significantly lower than the 5807 J/mL<sup>3</sup> in the
control group (<italic>P</italic> = 0.017).</p><p>All of the 89 patients completed preoperative and postoperative uroflow tests (<xref ref-type="table" rid="t2-cia-8-265">Table 2</xref>). Both groups had a similar preoperative peak
flow rate (8.71 mL/second and 7.88 mL/second in the control and aspirin groups, respectively) and
postoperative peak flow rate (13.64 mL/second and 13.54 mL/second in the control and aspirin groups,
respectively). The mean prostate volume of the aspirin group was comparable with the control group
(58.8 mL vs 51 mL; <italic>P</italic> = 0.16). The average postoperative decrease in
hemoglobin was 13.4 mg/ dL in the aspirin group versus 13.9 mg/dL in the control group
(<italic>P</italic> = 0.327). At 1 year followup the IPSS decreased to 80%, average
maximal urinary flow rate improved to 60%–80% and postvoid residual urine
volume decreased to 80%. Postoperative complications were low and comparable between
groups.</p></sec><sec sec-type="discussion"><title>Discussion</title><p>Aspirin, a common anticoagulant also known as acetylsalicylic acid, can be prescribed for a long
period of time at low doses to help prevent heart attacks, strokes, and blood clot formation in
people at high risk of developing coagulopathy.<xref ref-type="bibr" rid="b7-cia-8-265">7</xref></p><p>The primary mechanism by which aspirin impairs hemostasis is through irreversible acetylation of
enzyme cyclooxygenase (COX)-1. Because platelets have no nuclei and therefore retain only a limited
capacity to synthesize new proteins, a single small dose of aspirin (40–100 mg) or as little
as 10 mg taken daily for 1 week can completely inhibit Thromboxane A2 production and impair the
function of platelets for their circulating life span. Aspirin also acetylates the isoform of
cyclooxygenase, COX-2, which blocks synthesis of prostacyclin, a strong inhibitor of platelet
function.<xref ref-type="bibr" rid="b8-cia-8-265">8</xref>,<xref ref-type="bibr" rid="b9-cia-8-265">9</xref> Due to the high probability of bleeding, TURP is rarely performed in patients using
anticoagulants, and most patients are requested to stop taking the anticoagulants for at least 7
days before surgery. However, with the application of laser systems, endoscopic prostatectomy can be
performed with a better hemostatic effect. The GreenLight laser system, also known as the
potassium-titanyl-phosphate (KTP) laser, produces a green visible light beam of 532 nm by passing a
beam produced by neodymium-doped yttrium-aluminum-garnet through a KTP crystal that doubles its
frequency. Due to its shorter wavelength, it is selectively absorbed by oxyhemoglobin.<xref ref-type="bibr" rid="b5-cia-8-265">5</xref> The actual ablation of prostate tissue involves PVP
tissue rather than coagulation with earlier lasers.<xref ref-type="bibr" rid="b6-cia-8-265">6</xref>Laser radiation is delivered into the tissue using a side-firing fiber. In general, this type of
laser achieves good results in pure vaporization techniques, although enucleation procedures have
recently been reported.<xref ref-type="bibr" rid="b10-cia-8-265">10</xref>–<xref ref-type="bibr" rid="b15-cia-8-265">15</xref> The GreenLight laser system had been reported to be a
safe and effective surgery for those taking aspirin. Sohn et al reported that a 120 W HPS GreenLight
laser system was considered to be an effective and safe surgical method for those taking
anticoagulant medications for the treatment or prevention of cardiac or cerebral diseases without
ceasing medication.<xref ref-type="bibr" rid="b16-cia-8-265">16</xref> Chung et al also reported
that PVP using a 532 nm KTP laser can be safe and effective in patients at high risk of
anticoagulation, even those taking two or more anticoagulation agents and with a large prostate
requiring a lengthy operative time.<xref ref-type="bibr" rid="b17-cia-8-265">17</xref></p><p>Our results showed that both those taking and not taking aspirin had a similar age, prostate
volume, preoperative IPSS score, serum prostate-specific antigen, and hemoglobin levels. In
addition, there were no significant differences in the relevant coagulant factors such as PT, APTT,
and platelet count between the groups. However, the aspirin group required significantly less energy
to complete the laser prostatectomy for each gram of prostate volume than the control group (4297
J/cm<sup>3</sup> vs 5801 J/cm<sup>3</sup>, respectively; <italic>P</italic> = 0.017). We
hypothesized that this may be because during the laser prostatectomy, micro-hemorrhaging
continuously occurred in the rough surface of the prostate that was being vaporized by the laser. In
the aspirin group, due to the anticoagulant effect, this micro-hemorrhaging may have been more
obvious than in the non-aspirin group. This means that in the aspirin group, the hemoglobin density
around the surgical surface of the laser prostatectomy was higher than the control group. The
wavelength of the GreenLight laser is 532 nm and is mainly absorbed by oxyhemoglobin, which is a
chromophobe. Therefore, the more oxyhemoglobin appearing in the vaporized surface or the higher the
hemoglobin density, the more energy would be absorbed.</p><p>In the non-aspirin group, the energy that was not absorbed by the hemoglobin located in the
surgical surface may have penetrated deeper to the layer below, where coagulation rather than
vaporization occurred due to a lower energy concentration. In other words, more effective energy
utilization for vaporization may be achieved in the aspirin group. This could possibly explain why
the aspirin group needed less energy during laser prostatectomy with the GreenLight system to
achieve a similar improvement in uroflow tests in our study. Further studies with a larger number of
patients are required to elucidate these findings. In addition, more complete evaluation methods
such as postoperative IPSS questionnaires may be needed. On the other hand, we should also consider
how long the aspirin has been prescribed.</p></sec><sec><title>Conclusion</title><p>Photoselective vaporization is effective for lower urinary tract symptoms due to BPH. From our
treatment of BPH with vaporization, our subjective functional results, such as IPSS and quality of
life after GreenLight HPS management for BPH, were comparable between the patients who took aspirin
and those who did not take aspirin. However, the early objective functional results (maximum flow
rate and post-void residual) of PVP appear to be similar. By using PVP with GreenLight laser, the
group prescribed with aspirin required less energy to achieve similar therapeutic effect than the
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colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Mean age (range): 72.0 (52–93)</td><td align="left" valign="top" rowspan="1" colspan="1">71.7 (52–93)</td><td align="left" valign="top" rowspan="1" colspan="1">73.0 (56–86)</td><td align="left" valign="top" rowspan="1" colspan="1">0.561</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Total prostate volume</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 53.0 (25.3–122.1) (cm<sup>3</sup>)</td><td align="left" valign="top" rowspan="1" colspan="1">51.0 (28.7–90.0)</td><td align="left" valign="top" rowspan="1" colspan="1">58.8 (25.3–122.07)</td><td align="left" valign="top" rowspan="1" colspan="1">0.160</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Serum PSA level</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 7.15 (0.30–38.6) (ng/mL)</td><td align="left" valign="top" rowspan="1" colspan="1">7.62 (0.42–38.6)</td><td align="left" valign="top" rowspan="1" colspan="1">5.79 (0.302–13.32)</td><td align="left" valign="top" rowspan="1" colspan="1">0.242</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Hemoglobin</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 13.7 (8.8–17.3) (mg/dL)</td><td align="left" valign="top" rowspan="1" colspan="1">13.9 (9.3–17.3)</td><td align="left" valign="top" rowspan="1" colspan="1">13.4 (8.8–16.8)</td><td align="left" valign="top" rowspan="1" colspan="1">0.327</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">PT seconds</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 11.3 (9.9–17.7)</td><td align="left" valign="top" rowspan="1" colspan="1">11.2 (9.9–17.7)</td><td align="left" valign="top" rowspan="1" colspan="1">11.6 (10.0–13.0)</td><td align="left" valign="top" rowspan="1" colspan="1">0.115</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">APTT seconds</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 27.3 (20.9–37.2)</td><td align="left" valign="top" rowspan="1" colspan="1">27.3 (20.9–37.2)</td><td align="left" valign="top" rowspan="1" colspan="1">27.3 (22.9–33.0)</td><td align="left" valign="top" rowspan="1" colspan="1">0.979</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Platelet count</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 205056 (114,000–400,000)</td><td align="left" valign="top" rowspan="1" colspan="1">202,742 (114,000–400,000)</td><td align="left" valign="top" rowspan="1" colspan="1">211,695 (134,000–332,000)</td><td align="left" valign="top" rowspan="1" colspan="1">0.493</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">IPSS score</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 24.9 (15–35)</td><td align="left" valign="top" rowspan="1" colspan="1">24.9 (15–35)</td><td align="left" valign="top" rowspan="1" colspan="1">25.0 (19–33)</td><td align="left" valign="top" rowspan="1" colspan="1">0.883</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Lasing time</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 54.7 (10.0–135) (minutes)</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Energy consumption</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 275,702 (37,278–597,227) (Joule)</td><td align="left" valign="top" rowspan="1" colspan="1">289,793 (37,278–597,227)</td><td align="left" valign="top" rowspan="1" colspan="1">235,268 (71,864–557,902)</td><td align="left" valign="top" rowspan="1" colspan="1">0.097</td></tr><tr><td colspan="2" align="left" valign="top" rowspan="1">Energy consumption per prostate volume
(Joule/cm<sup>3</sup>)</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 5412 (1165–15,121)</td><td align="left" valign="top" rowspan="1" colspan="1">5801 (1165–15,121)</td><td align="left" valign="top" rowspan="1" colspan="1">4297 (1311–10,811)</td><td align="left" valign="top" rowspan="1" colspan="1">0.017</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Aspirin prescription</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Yes 23</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> No 66</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn id="tfn1-cia-8-265"><p><bold>Abbreviations:</bold> PSA, prostate-specific antigen; PT, prothrombin time; APTT, activated
partial thromboplastin time; IPSS, International Prostate Symptom Score.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-cia-8-265" position="float"><label>Table 2</label><caption><p>Results of uroflow data</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1"><bold>(mL/second)</bold></th><th align="left" valign="top" rowspan="1" colspan="1"><bold>Non-aspirin group (mean)</bold></th><th align="left" valign="top" rowspan="1" colspan="1"><bold>Aspirin group (mean/range)</bold></th><th align="left" valign="top" rowspan="1" colspan="1"><bold><italic>P</italic>-value</bold></th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Preoperative peak flow rate</td><td align="left" valign="top" rowspan="1" colspan="1">8.71</td><td align="left" valign="top" rowspan="1" colspan="1">7.88</td><td align="left" valign="top" rowspan="1" colspan="1">0.681</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Postoperative peak flow rate</td><td align="left" valign="top" rowspan="1" colspan="1">13.64</td><td align="left" valign="top" rowspan="1" colspan="1">13.54</td><td align="left" valign="top" rowspan="1" colspan="1">0.967</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Preoperative average flow rate</td><td align="left" valign="top" rowspan="1" colspan="1">3.76</td><td align="left" valign="top" rowspan="1" colspan="1">3.62</td><td align="left" valign="top" rowspan="1" colspan="1">0.869</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Postoperative average flow rate</td><td align="left" valign="top" rowspan="1" colspan="1">6.42</td><td align="left" valign="top" rowspan="1" colspan="1">6.57</td><td align="left" valign="top" rowspan="1" colspan="1">0.896</td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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