Bleeding Risk of Cystoscopy with GreenLight Ablation of Prostate
GreenLight laser photoselective vaporization of the prostate (PVP) has a lower bleeding risk compared to traditional transurethral resection of the prostate (TURP), with shorter catheterization times, lower transfusion rates, and fewer clot retention episodes. 1
Bleeding Risk Profile
- GreenLight PVP demonstrates shorter catheterization and hospitalization times, as well as lower transfusion and clot retention episode rates compared to TURP 1
- Evidence from case series shows that the 80-W, 120-W, and 180-W GreenLight lasers are safe in high-risk patients and in those receiving anticoagulation 1
- The hemostatic properties of GreenLight laser make it particularly suitable for patients with increased bleeding risk 1
Specific Bleeding Outcomes
- Studies demonstrate that patients undergoing GreenLight PVP rarely require blood transfusions, even those on anticoagulant medications 2
- In a study of patients on oral anticoagulants undergoing 120-W HPS GreenLight laser PVP, no major postsurgical complications requiring transfusion were observed during a 12-week follow-up period 2
- A retrospective analysis found no significant change in serum hematocrit (40.0% to 38.3%) in patients on anticoagulants undergoing GreenLight PVP 3
Safety in High-Risk Patients
- GreenLight PVP can be safely performed in patients taking anticoagulant and/or antiplatelet medications 1, 3
- A study of high-risk patients on antithrombotic therapy treated with GreenLight XPS-180W showed that while minor bleeding events and readmission rates were higher, serious bleeding complications were rare and equivalent to non-high-risk patients 4
- In elderly patients (≥75 years old), GreenLight laser PVP demonstrated an excellent safety profile with only two cases of Clavien grade III complications in a large cohort of 320 patients 5
Comparison with Other Techniques
- The 180-W PVP is noninferior to TURP in terms of perioperative complications 1
- The reoperation rate after 180-W XPS laser was comparable with that after TURP but was significantly higher after 120-W HPS laser (11% vs 1.8%; p = 0.04) 1
- An RCT comparing PVP with HoLEP in patients with prostate volume >60 ml showed comparable symptomatic improvement, but PVP had a 22% conversion rate to TURP 1
Bleeding Risk in Anticoagulated Patients
- Patients on warfarin typically discontinue the drug 2 days prior to surgery and restart it the day after, while antiplatelet agents like aspirin and clopidogrel can often be continued throughout the perioperative period 3
- In a study of patients on various antithrombotic therapies (aspirin, other antiplatelet agents, or anticoagulants), the overall 30-day complication rates were 31%, 28.7%, 45.8%, and 45.9% respectively, with most being minor complications 4
- Hematuria Clavien grade 1 events, readmission rates, length of post-operative hospital stay, and catheterization time were significantly higher in patients on antiplatelet and anticoagulation medication, but serious bleeding events were not increased 4
Technique Considerations to Minimize Bleeding
- The anatomic vaporization-incision technique (VIT) using the XPS LBO-180W system can be used to address larger prostate volumes while maintaining the hemostatic advantages of GreenLight laser 6
- Proper cystoscopy, knowledge of prostate anatomy with preoperative ultrasound, and routine technique are essential to developing consistent, reproducible and optimal surgical outcomes with minimal bleeding 6
Pitfalls and Caveats
- Despite the overall safety profile, patients on antiplatelet and anticoagulation medication should be counseled on the increased risk of minor bleeding events and readmission rates at 30 days after surgery 4
- The 22% conversion rate to TURP when using PVP for prostates >60ml should be considered when planning the procedure 1
- While GreenLight PVP has excellent hemostatic properties, proper surgical technique and patient selection remain important to minimize bleeding complications 6