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MP27-09 PREDICTORS OF POSTOPERATIVE BACTERIURIA AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Saturday, May 13, 2017
e331
MP27-07
MP27-08
CAN WE PREDICT THE LEARNING CURVE FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) BY USING SIMULTANEOUS PARAMETER OF ENUCLEATION-MORCELLATION?
ASSESSMENT OF THE LEARNING CURVES FOR INTRAVESICAL ADENOMA MORCELLATION USING? PIRANHAÓ DEVICE DURING ENDOSCOPIC ENUCLEATION?
Sung Tae Cho*, Don Kyoung Choi, Ohseong Kwon, Young Goo Lee, Ki Kyung Kim, Seoul, Korea, Republic of; Kyungtae Ko, Seoul , Korea, Republic of
Benjamin PRADERE*, Tours, France; Benoit PEYRONNET, Rennes, France; Benoit Bordier, Julien Guillotreau, Toulouse, France; Kevin Zorn, Montreal, Canada; Vincent Misraï, Toulouse, France
INTRODUCTION AND OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive laser therapy for benign prostatic hyperplasia. However, a steep operative learning curve may be the main drawback to use of HoLEP. The enucleation ratio or efficacy were known as one of the parameters for estimating the learning curve. But this parameter is only focused on time of enucleation not considering morcellation, even though operators spend time of enucleation and morcellation simultaneously during HoLEP surgery. The aim of this study was to evaluate a various method to assess the learning curve of HoLEP of a single surgeon. METHODS: Ninety-two consecutive cases performed by the single surgeon were enrolled. Intraoperative measures, including enucleation time, enucleation ratio (enucleated weight/transitional zone volume), enucleation efficacy (enucleated weight / enucleation time), consumed energy, morcellation time, morcellation efficacy (enucleated weight / morcellation time) and enucleationmorcellation efficacy (enucleated weight/enucleation and morcellation time) were analyzed. Perioperative morbidity, length of hospital stay and length of urinary drainage were also investigated. In addition, functional outcomes such as Qmax, post-void residual volume, IPSS and QoL scores at 3 and 6months were also investigated. RESULTS: The mean age of the patients was 72.9 years (49-86) with a mean prostate volume of 59.2 cc (34-180) on transrectal ultrasonography. Within all procedures, mean total operative time was 86.5 minutes (45-260 minutes) with a mean enucleated weight of 42.2 g (25-120 g). Mean enucleation time, consumed energy, morcellation time and enucleation ratio were 48.9 12.1 min, 67.5 22.8 kJ, 22.4 14.5 min and 0.64 0.32 g/mL, respectively. In terms of efficiency, enucleation efficacy, morcellation efficacy and enucleation-morcellation efficacy were 0.42 0.37 g/min, 4.24 1.26 g/min and 0.24 0.11 g/min, respectively. Perioperative complications were observed in 12 of 92 (13.0%). Of these, 10 were urinary tract infection and 2 was urethral stricture. Considering the learning curve, the plateau of enucleation efficacy was reached after 38 cases. However, considering enucleation and morcellation time simultaneously, enucleationmorcellation efficacy has an increasing trend even after 38 cases and has remained roughly constant after 55 cases. Based on these criteria, we divided cases into two groups. Enucleation efficiency was significantly higher after 38 cases. Morcellation efficiency was also higher in the second group, however, the difference was not significant. Enucleation-morcellation efficiency was significantly higher after 55 cases. Perioperative morbidities, hospital length of stay, urinary drainage length and functional outcomes at 3 and 6months were not significantly different between the groups based on these criteria. CONCLUSIONS: Although the learning curve did not interfere with functional results, our results demonstrated that even after 38 cases, surgical skill advances are still needed. Of these factors, morcellation time is as important as enucleation time in the whole surgical procedure. Enucleation-morcellation efficacy might be considered a better parameter for estimating the operative learning curve of HoLEP rather than enucleation efficacy alone.
INTRODUCTION AND OBJECTIVES: Morcellation of intravesical adenoma (MIA) is an important part of the endo- scopic enucleation procedure. The aim of this study was to analyse the learning curve of the MIA during endoscopic enucleation of the prostate.? METHODS: We conducted a prospective study of the first 90 patients treated by endoscopic enu- cleation of the prostate by a single surgeon without previous experience of MIA. The population was divided into 3 consecutive groups of 30 patients. MIA was performed with the morcella- tor Pinranha (Wolfâ) and disposable blades (VmaxÓ). The criteria selected to assess the progress of MIA over time were: duration of MIA (min), the intraoperative complications encountered during MIA and weight morcelleted tissue. The efficacy of MIA was assessed with the ratio weight specimen/MIA duration (min/g) over time. RESULTS: The three groups were comparable in terms of age, ASA score of prostate volume. A significant decrease in the duration of MIA was found between groups 1 and 2 (12 versus 5.5 min, P < 0.0001), to reach a plateau in the group 3 (3 min). A significant increase in the efficiency of MIA was found between group 1 and 2 (5.5 versus 11 g/min, P < 0.0001), to reach a plateau in the group 3 (20 g/min) (Figure 1). Bladder injuries were limited (7.7%), superficial and encountered in the early learning phase. CONCLUSIONS: In our experience, the MIA required a learning curve estimated between 30 and 60 procedures.
Source of Funding: None
Source of Funding: None
MP27-09 PREDICTORS OF POSTOPERATIVE BACTERIURIA AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Amr Elmekresh*, Victor Villarreal II, Jordyn Farewell, Karen Doersch, Marawan El Tayeb, Temple, TX INTRODUCTION AND OBJECTIVES: Transient non-bothersome, irritative bladder symptoms are not uncommon following HoLEP,
THE JOURNAL OF UROLOGYâ
e332
and thus urine culture (UCx) is obtained to differentiate between expected transient irritative symptoms and urinary tract infection (UTI). Our aim is to evaluate the predictors and risk factors of postoperative bacteriuria at 6 weeks post HoLEP in an attempt to decrease the postoperative routine UCx analysis. METHODS: After IRB approval, a retrospective chart review of 100 patients who had HoLEP between August 2015 and June 2016. It is a protocol at our institution that UCx analysis is performed at the 6 weeks postoperatively. All patients had urine cultures’ results preoperatively and 6 weeks postoperatively. Patients’ demographics, Preoperative, operative and postoperative characteristics data were obtained and analyzed. Statistical analysis was performed using USPSS and included means with standard deviation, Chi-square test, and Independent T-test when appropriate. RESULTS: A total of 100 patients were identified, 18 patients in group (A) who had positive postoperative UCx at 6 weeks after HoLEP versus 82 patients in group (B) who had negative postoperative UCx. Patients’ demographics were comparable with no statistical significance between both cohorts. 11 (61.1%) vs 22 (26.2%) patients had preoperative positive UCx in groups (A) and (B), respectively, (p¼0.052). A preoperative history of UTI was noted in 7 (38.8%) vs. 28 (34.1%) patients in groups (A) and (B), respectively, (P¼ 0). Preoperative Urine retention was present 3 vs. 12 in groups (A) and (B) with a mean length of catheterization (LOC) of 60 vs. 75.58 days, respectively, (p¼ 0.708). Mean preoperative PVR was 116.45 vs. 145.48 mls in groups (A) and (B), respectively, (p¼ 0.463). Mean preoperative BPH impact index was 5.85 vs. 5.1 in groups (A) and (B), respectively, (p¼ 0.439). Mean preoperative AUA score is 22.2 vs. 24.48 in groups (A) and (B), respectively, (P¼ 0.383). Mean OR specimen weight was 68.6 vs. 51.5 gms in groups (A) and (B), respectively, (p¼ 0.294). Enucleation and morcellation times were comparable with no statistical significance. Postoperative LOC was 1.6 vs. 1.9 in groups (A) and (B), respectively, (p¼0.323). Mean postoperative PVR at 6 weeks was 77.5 vs. 45.7 mls in groups (A) and (B), respectively, (p¼ 0.014). Mean AUA score mean at 6 weeks was comparable at 5.66 vs. 8.2 in groups (A) and (B), respectively, (p¼ 0.153). CONCLUSIONS: The sole predictor of postoperative bacteriuria is the elevated PVR; we recommend obtaining routine UCx for patients who presents with PVR above 50 ml. Source of Funding: none
MP27-10 ROLE OF DEBULKING PROCEDURES IN MEN WITH PROSTATES LESS THAN 40 GRAMS. Ramy Goueli*, Lesa Deonarine, Dominique Thomas, Kristina Navrazhina, New York, NY; Kelsey Lawson, Malek Meskawi, Marc Zanaty, ’Montreal, Canada; Vincent Misrai, Toulouse, France; Roger Valdivieso, Pierre-Alain Hueber, Kevin Zorn, ’Montreal, Canada; Alexis Te, Bilal Chughtai, New York, NY INTRODUCTION AND OBJECTIVES: There is a dearth of evidence showing a long-term benefit of performing debulking procedure in small volume prostates (<40grams), with no evidence in using 180-W XPS-greenlight system in this population. Our objective was to characterize the long term clinical and symptomatic benefit of the 180-W XPS-Greenlight laser in patients with small volume prostates. METHODS: A retrospective analysis of 58 patients who underwent 180-W XPS-laser PVP vaporization of the prostate between 2012 and 2016 at three tertiary medical centers. We included all comers with prostates less than 40 grams with clinical evidence of bladder outlet obstruction. RESULTS: The average age of men who underwent PVP of the prostate was 67.810.9 years old, with an average BMI of 29.73.9. The average prostate volume was 296.7mL, five
Vol. 197, No. 4S, Supplement, Saturday, May 13, 2017
patients were found to have a significant intravesicular median lobe. Three patients had pre-operative retention requiring catheterization, 45 patients were using an alpha blocker and 41 were using a 5-alpha reductase inhibitor. The average operative time was 45.122.1 minutes, laser time of 20.9 13 minutes, and energy of 14696.8 kilojoules. All patients were discharged from the hospital within 48 hours of the procedure, five patients were discharged with a catheter. The median follow up time was 6 months (IQR 3-22.5), there were 12 complications within 30 days, including 2 patients with persistent retention, 4 patients had urinary tract infections, 4 patients had severe urgency requiring medications, one patient had intermittent hematuria and 1 patient had a paraphimosis. There was no incidence of stricture or bladder neck up to four years of follow up. The IPSS score improved from was 22.87 at baseline 0.77 (p<0.01) and 6.314.4 (p<0.01) at 30 and 180 days, respectively. The maximal flow rate improved from 7.74.6 ml/sec at baseline to 17.259.3 mL/sec (p<0.01) and 19.147.19 (p<0.001) at 30 and 180 days, respectively, while the PVR improved from 216271 mL pre-operatively to 32.845.3 (p<0.01) and 26.2346 (p<0.01) at 30 and 180 days, respectively. The PSA drop from 1.971.76 ng/mL pre-operatively to 0.740.63 ng/mL 180 days, respectively. CONCLUSIONS: Photovaporzation of prostates smaller than 40 grams with the 180-W XPS-laser has been shown to have a durable improvement in symptomatic and clinical parameters. Source of Funding: None
MP27-11 COMPLICATIONS AND FUNCTIONAL OUTCOMES OF HIGH-RISK PATIENT WITH CARDIOVASCULAR DISEASE NECESSITATING ACO TREATED WITH THE 532NM-LASER PHOTO-VAPORIZATION GREENLIGHT XPS 180W Roger Valdivieso*, Pierre-Alain Hueber, Malek Meskawi, Marc Zanaty, Kelsey Lawson, Mounsif Azizi, Montreal, Canada; Benjamin Pradere, Toulouse, France; Kevin Zorn, Montreal, Canada; Vincent Misrai, Toulouse, France INTRODUCTION AND OBJECTIVES: According to AUA guidelines Greenlight PVP 532-nm laser vaporization of the prostate should be considered in patients receiving anticoagulant medication or with a high cardiovascular risk. We sought to examine the functional and complications outcomes of high risk patients with cardiovascular disease necessitating maintenance of anticoagulation therapy (ACO). METHODS: Retrospective analysis of prospectively maintained institutional database was performed. Men were stratified according to ACO treatment status defined as the usage of anti-vitamin K, Heparin, direct thrombin inhibitor or and anti-Xa. Complications at 30 and 90 days according to Clavien classification and functional outcomes (IPSS, Qmax and PVR) were analyzed up to 5-years follow-up. RESULTS: A total of 39 (10%) patients were on ACO including 8 patients with prosthetic cardiac valve, 26 patients with malignant arrhythmias and 27 with coronary cardiac disease. ACO patients were older (75 vs 67 years, p<0.01) and with more systemic disease defined by ASA score. Men with ACO were more likely to fail first trial of void, had significant longer catheterization time 1.7 vs 1 days and longer hospitalization 2.5 vs 0.5 days respectively (p<0.01 for all). ACO men had also higher 30 days readmission rate of 16% and higher rate of hematuria observed in almost 1/3 of the cases. Functional outcomes were significantly improved and equivalent to non ACO patients at all endpoints including at 5-year. CONCLUSIONS: This is the first study to look at safety and functional outcomes of patients with cardiovascular disease requiring ACO with 5 years follow-up. PVP provide significant and durable treatment for symptomatic BPH in these high-risk ACO patient. However treatment comes with an increased risk of bleeding
Vol. 197, No. 4S, Supplement, Saturday, May 13, 2017
e331
MP27-07
MP27-08
CAN WE PREDICT THE LEARNING CURVE FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) BY USING SIMULTANEOUS PARAMETER OF ENUCLEATION-MORCELLATION?
ASSESSMENT OF THE LEARNING CURVES FOR INTRAVESICAL ADENOMA MORCELLATION USING? PIRANHAÓ DEVICE DURING ENDOSCOPIC ENUCLEATION?
Sung Tae Cho*, Don Kyoung Choi, Ohseong Kwon, Young Goo Lee, Ki Kyung Kim, Seoul, Korea, Republic of; Kyungtae Ko, Seoul , Korea, Republic of
Benjamin PRADERE*, Tours, France; Benoit PEYRONNET, Rennes, France; Benoit Bordier, Julien Guillotreau, Toulouse, France; Kevin Zorn, Montreal, Canada; Vincent Misraï, Toulouse, France
INTRODUCTION AND OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive laser therapy for benign prostatic hyperplasia. However, a steep operative learning curve may be the main drawback to use of HoLEP. The enucleation ratio or efficacy were known as one of the parameters for estimating the learning curve. But this parameter is only focused on time of enucleation not considering morcellation, even though operators spend time of enucleation and morcellation simultaneously during HoLEP surgery. The aim of this study was to evaluate a various method to assess the learning curve of HoLEP of a single surgeon. METHODS: Ninety-two consecutive cases performed by the single surgeon were enrolled. Intraoperative measures, including enucleation time, enucleation ratio (enucleated weight/transitional zone volume), enucleation efficacy (enucleated weight / enucleation time), consumed energy, morcellation time, morcellation efficacy (enucleated weight / morcellation time) and enucleationmorcellation efficacy (enucleated weight/enucleation and morcellation time) were analyzed. Perioperative morbidity, length of hospital stay and length of urinary drainage were also investigated. In addition, functional outcomes such as Qmax, post-void residual volume, IPSS and QoL scores at 3 and 6months were also investigated. RESULTS: The mean age of the patients was 72.9 years (49-86) with a mean prostate volume of 59.2 cc (34-180) on transrectal ultrasonography. Within all procedures, mean total operative time was 86.5 minutes (45-260 minutes) with a mean enucleated weight of 42.2 g (25-120 g). Mean enucleation time, consumed energy, morcellation time and enucleation ratio were 48.9 12.1 min, 67.5 22.8 kJ, 22.4 14.5 min and 0.64 0.32 g/mL, respectively. In terms of efficiency, enucleation efficacy, morcellation efficacy and enucleation-morcellation efficacy were 0.42 0.37 g/min, 4.24 1.26 g/min and 0.24 0.11 g/min, respectively. Perioperative complications were observed in 12 of 92 (13.0%). Of these, 10 were urinary tract infection and 2 was urethral stricture. Considering the learning curve, the plateau of enucleation efficacy was reached after 38 cases. However, considering enucleation and morcellation time simultaneously, enucleationmorcellation efficacy has an increasing trend even after 38 cases and has remained roughly constant after 55 cases. Based on these criteria, we divided cases into two groups. Enucleation efficiency was significantly higher after 38 cases. Morcellation efficiency was also higher in the second group, however, the difference was not significant. Enucleation-morcellation efficiency was significantly higher after 55 cases. Perioperative morbidities, hospital length of stay, urinary drainage length and functional outcomes at 3 and 6months were not significantly different between the groups based on these criteria. CONCLUSIONS: Although the learning curve did not interfere with functional results, our results demonstrated that even after 38 cases, surgical skill advances are still needed. Of these factors, morcellation time is as important as enucleation time in the whole surgical procedure. Enucleation-morcellation efficacy might be considered a better parameter for estimating the operative learning curve of HoLEP rather than enucleation efficacy alone.
INTRODUCTION AND OBJECTIVES: Morcellation of intravesical adenoma (MIA) is an important part of the endo- scopic enucleation procedure. The aim of this study was to analyse the learning curve of the MIA during endoscopic enucleation of the prostate.? METHODS: We conducted a prospective study of the first 90 patients treated by endoscopic enu- cleation of the prostate by a single surgeon without previous experience of MIA. The population was divided into 3 consecutive groups of 30 patients. MIA was performed with the morcella- tor Pinranha (Wolfâ) and disposable blades (VmaxÓ). The criteria selected to assess the progress of MIA over time were: duration of MIA (min), the intraoperative complications encountered during MIA and weight morcelleted tissue. The efficacy of MIA was assessed with the ratio weight specimen/MIA duration (min/g) over time. RESULTS: The three groups were comparable in terms of age, ASA score of prostate volume. A significant decrease in the duration of MIA was found between groups 1 and 2 (12 versus 5.5 min, P < 0.0001), to reach a plateau in the group 3 (3 min). A significant increase in the efficiency of MIA was found between group 1 and 2 (5.5 versus 11 g/min, P < 0.0001), to reach a plateau in the group 3 (20 g/min) (Figure 1). Bladder injuries were limited (7.7%), superficial and encountered in the early learning phase. CONCLUSIONS: In our experience, the MIA required a learning curve estimated between 30 and 60 procedures.
Source of Funding: None
Source of Funding: None
MP27-09 PREDICTORS OF POSTOPERATIVE BACTERIURIA AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Amr Elmekresh*, Victor Villarreal II, Jordyn Farewell, Karen Doersch, Marawan El Tayeb, Temple, TX INTRODUCTION AND OBJECTIVES: Transient non-bothersome, irritative bladder symptoms are not uncommon following HoLEP,
THE JOURNAL OF UROLOGYâ
e332
and thus urine culture (UCx) is obtained to differentiate between expected transient irritative symptoms and urinary tract infection (UTI). Our aim is to evaluate the predictors and risk factors of postoperative bacteriuria at 6 weeks post HoLEP in an attempt to decrease the postoperative routine UCx analysis. METHODS: After IRB approval, a retrospective chart review of 100 patients who had HoLEP between August 2015 and June 2016. It is a protocol at our institution that UCx analysis is performed at the 6 weeks postoperatively. All patients had urine cultures’ results preoperatively and 6 weeks postoperatively. Patients’ demographics, Preoperative, operative and postoperative characteristics data were obtained and analyzed. Statistical analysis was performed using USPSS and included means with standard deviation, Chi-square test, and Independent T-test when appropriate. RESULTS: A total of 100 patients were identified, 18 patients in group (A) who had positive postoperative UCx at 6 weeks after HoLEP versus 82 patients in group (B) who had negative postoperative UCx. Patients’ demographics were comparable with no statistical significance between both cohorts. 11 (61.1%) vs 22 (26.2%) patients had preoperative positive UCx in groups (A) and (B), respectively, (p¼0.052). A preoperative history of UTI was noted in 7 (38.8%) vs. 28 (34.1%) patients in groups (A) and (B), respectively, (P¼ 0). Preoperative Urine retention was present 3 vs. 12 in groups (A) and (B) with a mean length of catheterization (LOC) of 60 vs. 75.58 days, respectively, (p¼ 0.708). Mean preoperative PVR was 116.45 vs. 145.48 mls in groups (A) and (B), respectively, (p¼ 0.463). Mean preoperative BPH impact index was 5.85 vs. 5.1 in groups (A) and (B), respectively, (p¼ 0.439). Mean preoperative AUA score is 22.2 vs. 24.48 in groups (A) and (B), respectively, (P¼ 0.383). Mean OR specimen weight was 68.6 vs. 51.5 gms in groups (A) and (B), respectively, (p¼ 0.294). Enucleation and morcellation times were comparable with no statistical significance. Postoperative LOC was 1.6 vs. 1.9 in groups (A) and (B), respectively, (p¼0.323). Mean postoperative PVR at 6 weeks was 77.5 vs. 45.7 mls in groups (A) and (B), respectively, (p¼ 0.014). Mean AUA score mean at 6 weeks was comparable at 5.66 vs. 8.2 in groups (A) and (B), respectively, (p¼ 0.153). CONCLUSIONS: The sole predictor of postoperative bacteriuria is the elevated PVR; we recommend obtaining routine UCx for patients who presents with PVR above 50 ml. Source of Funding: none
MP27-10 ROLE OF DEBULKING PROCEDURES IN MEN WITH PROSTATES LESS THAN 40 GRAMS. Ramy Goueli*, Lesa Deonarine, Dominique Thomas, Kristina Navrazhina, New York, NY; Kelsey Lawson, Malek Meskawi, Marc Zanaty, ’Montreal, Canada; Vincent Misrai, Toulouse, France; Roger Valdivieso, Pierre-Alain Hueber, Kevin Zorn, ’Montreal, Canada; Alexis Te, Bilal Chughtai, New York, NY INTRODUCTION AND OBJECTIVES: There is a dearth of evidence showing a long-term benefit of performing debulking procedure in small volume prostates (<40grams), with no evidence in using 180-W XPS-greenlight system in this population. Our objective was to characterize the long term clinical and symptomatic benefit of the 180-W XPS-Greenlight laser in patients with small volume prostates. METHODS: A retrospective analysis of 58 patients who underwent 180-W XPS-laser PVP vaporization of the prostate between 2012 and 2016 at three tertiary medical centers. We included all comers with prostates less than 40 grams with clinical evidence of bladder outlet obstruction. RESULTS: The average age of men who underwent PVP of the prostate was 67.810.9 years old, with an average BMI of 29.73.9. The average prostate volume was 296.7mL, five
Vol. 197, No. 4S, Supplement, Saturday, May 13, 2017
patients were found to have a significant intravesicular median lobe. Three patients had pre-operative retention requiring catheterization, 45 patients were using an alpha blocker and 41 were using a 5-alpha reductase inhibitor. The average operative time was 45.122.1 minutes, laser time of 20.9 13 minutes, and energy of 14696.8 kilojoules. All patients were discharged from the hospital within 48 hours of the procedure, five patients were discharged with a catheter. The median follow up time was 6 months (IQR 3-22.5), there were 12 complications within 30 days, including 2 patients with persistent retention, 4 patients had urinary tract infections, 4 patients had severe urgency requiring medications, one patient had intermittent hematuria and 1 patient had a paraphimosis. There was no incidence of stricture or bladder neck up to four years of follow up. The IPSS score improved from was 22.87 at baseline 0.77 (p<0.01) and 6.314.4 (p<0.01) at 30 and 180 days, respectively. The maximal flow rate improved from 7.74.6 ml/sec at baseline to 17.259.3 mL/sec (p<0.01) and 19.147.19 (p<0.001) at 30 and 180 days, respectively, while the PVR improved from 216271 mL pre-operatively to 32.845.3 (p<0.01) and 26.2346 (p<0.01) at 30 and 180 days, respectively. The PSA drop from 1.971.76 ng/mL pre-operatively to 0.740.63 ng/mL 180 days, respectively. CONCLUSIONS: Photovaporzation of prostates smaller than 40 grams with the 180-W XPS-laser has been shown to have a durable improvement in symptomatic and clinical parameters. Source of Funding: None
MP27-11 COMPLICATIONS AND FUNCTIONAL OUTCOMES OF HIGH-RISK PATIENT WITH CARDIOVASCULAR DISEASE NECESSITATING ACO TREATED WITH THE 532NM-LASER PHOTO-VAPORIZATION GREENLIGHT XPS 180W Roger Valdivieso*, Pierre-Alain Hueber, Malek Meskawi, Marc Zanaty, Kelsey Lawson, Mounsif Azizi, Montreal, Canada; Benjamin Pradere, Toulouse, France; Kevin Zorn, Montreal, Canada; Vincent Misrai, Toulouse, France INTRODUCTION AND OBJECTIVES: According to AUA guidelines Greenlight PVP 532-nm laser vaporization of the prostate should be considered in patients receiving anticoagulant medication or with a high cardiovascular risk. We sought to examine the functional and complications outcomes of high risk patients with cardiovascular disease necessitating maintenance of anticoagulation therapy (ACO). METHODS: Retrospective analysis of prospectively maintained institutional database was performed. Men were stratified according to ACO treatment status defined as the usage of anti-vitamin K, Heparin, direct thrombin inhibitor or and anti-Xa. Complications at 30 and 90 days according to Clavien classification and functional outcomes (IPSS, Qmax and PVR) were analyzed up to 5-years follow-up. RESULTS: A total of 39 (10%) patients were on ACO including 8 patients with prosthetic cardiac valve, 26 patients with malignant arrhythmias and 27 with coronary cardiac disease. ACO patients were older (75 vs 67 years, p<0.01) and with more systemic disease defined by ASA score. Men with ACO were more likely to fail first trial of void, had significant longer catheterization time 1.7 vs 1 days and longer hospitalization 2.5 vs 0.5 days respectively (p<0.01 for all). ACO men had also higher 30 days readmission rate of 16% and higher rate of hematuria observed in almost 1/3 of the cases. Functional outcomes were significantly improved and equivalent to non ACO patients at all endpoints including at 5-year. CONCLUSIONS: This is the first study to look at safety and functional outcomes of patients with cardiovascular disease requiring ACO with 5 years follow-up. PVP provide significant and durable treatment for symptomatic BPH in these high-risk ACO patient. However treatment comes with an increased risk of bleeding