Anticoagulation, photoselective vaporization of the prostate and safety : a propensity score-matched study.

Purpose: We compared surgical complications after laser prostatic photovaporization in anticoagulated versus non-anticoagulated patients.

Methods: A propensity score was calculated and patients were matched, to compare postoperative complications using the Clavien-Dindo classification between the anticoagulated and non-anticoagulated groups. We also identified factors associated with complications, and perform an analysis of secondary endpoint with categories of urological complications.

Results: We included all patients that benefited a photovaporization between 2013 and 2022, either 811 patients, reducing to 245 after propensity score matching for anticoagulation. After propensity score matching, there were no differences in baseline characteristics between groups. Ninety five patients (38%) were receiving anticoagulants; 162 (66%) had an ASA score ≥ 3. Among 86 patients (35%) who experienced complications within 3 months postoperatively, 92% had a Clavien Dindo score ≤ 2. By multivariate analysis, anticoagulation was not statistically significant, the only significant risk factor for complications was ASA score ≥ 3 (Odds ratio (OR) 2.2; 95% confidence interval (CI) [1.2-4.1]). Secondary endpoint analysis for hematuria found ASA score of 3 or higher and anticoagulant treatment statistically significant in univariate and multivariate analysis, with OR of 2.9 (95% CI [1.1-7.4]) and OR of 3.5 (95% CI [1.7-7.5]), respectively.

Conclusion: Green light laser photovaporization of the prostate demonstrates significant safety, even in frail patients on anticoagulant therapy.