warfarin and Prostatic-Hyperplasia

In the present study we aimed to demonstrate the efficacy of short-term pretreatment with finasteride in patients undergoing transurethral resection of the prostate (TUR-P). For this purpose 40 patients with BPH, who were candidates for TUR-P, were randomized into two groups. The first group (n=20) received 5 mg finasteride/day for 4 weeks prior to surgery and the second group (n=20) remained as the control. Patients who underwent prior prostate or urethral surgery and had a diagnosis of prostate cancer or chronic renal failure, patients who received finasteride, aspirin, coumadin or similar anticoagulant drugs prior to surgery and patients who had capsule perforations or open sinuses during the surgery were excluded from the study. All patients had a normal digital rectal examination and PSA values less than 4 ng/ml. As we look at the results there was no statistically significant difference between the finasteride group and control group regarding age, IPSS, PSA, prostate volumes, preoperative serum hemoglobin, hematocrit values and mean operating times and used irrigating fluids. The total amount of bleeding and bleeding per gram resected tissue were significantly lower in the finasteride group regardless of prostate volume. Furthermore the decrease in the hemoglobin and hematocrit values was higher in the control group. As a conclusion four weeks of finasteride pretreatment provided a significant decrease in peroperative bleeding regardless of prostate volume without any major side effects.

Topics: Age Factors; Aged; Anticoagulants; Aspirin; Finasteride; Hemoglobins; Humans; Male; Middle Aged; Prostate; Prostate-Specific Antigen; Prostatic Hyperplasia; Prostatic Neoplasms; Renal Insufficiency; Risk; Time Factors; Transurethral Resection of Prostate; Urethra; Warfarin

Transurethral Nd:YAG laser ablation of the prostate gland was used to treat benign prostatic hyperplasia (BPH) in 20 patients on Warfarin anticoagulant therapy, and in two patients with abnormal coagulation parameters secondary to haematologic disorders. Preliminary results for the first 10 of these patients has been reported previously. The mean pre-operative international normalized ratio (INR) was 2.6 (range 1.19 to 5.25) and the mean prostate volume was 56 cc (13.6-112 cc). All patients had significant subjective and objective indicators of prostatic obstruction and six patients were in urinary retention. Postoperative improvement in symptom score, maximum flow rate and post-void residual was noted in 82% of patients at 3 months, 89% at 6 months and 75% at 1 year. Two patients have required revision laser or transurethral resection of the prostate (TURP) for persistent obstruction, while one patient required revision TURP for intractable haematuria. Three patients developed haematuria requiring transfusion while four patients had mild haematuria requiring no intervention. Laser ablation of the prostate can be used successfully and safely to treat prostatic obstruction in patients with abnormal coagulation parameters, or in those who are fully anticoagulated. Anticoagulation can be maintained during surgery in this group unlike TURP where pre-operative reversal is necessary with reinstitution of therapy several days postoperatively. Other authors report at least a 50% blood transfusion rate in this group. Laser prostatectomy appears the more appealing surgical option in these patients.

Topics: Aged; Aged, 80 and over; Blood Coagulation; Heart Valve Prosthesis; Humans; Laser Therapy; Male; Middle Aged; Platelet Count; Prostatectomy; Prostatic Hyperplasia; Prothrombin Time; Thrombophlebitis; Warfarin

A series of indoline and indole derivatives were designed, synthesized, and evaluated as selective α1A-adrenergic receptor (α1A-AR) antagonists for the treatment of benign prostatic hyperplasia (BPH). In this study, two highly selective and potent α1A-AR antagonists, compounds (R)-14r (IC50 = 2.7 nM, α1B/α1A = 640.1, α1D/α1A = 408.2) and (R)-23l (IC50 = 1.9 nM, α1B/α1A = 1506, α1D/α1A = 249.6), which exhibited similar activities and better selectivities in cell-based calcium assays as compared with the marketed drug silodosin (IC50 = 1.9 nM, α1B/α1A = 285.9, α1D/α1A = 14.4), were identified. In the functional assays with isolated rat tissues, compounds (R)-14r and (R)-23l also showed high potency and uroselectivity. Most importantly, (R)-14r and (R)-23l can significantly decrease the micturition frequency and increase the mean voided volume of the BPH rats in a dose-dependent manner, making them worthy of further investigation for the development of anti-BPH agents.

Topics: Adrenergic alpha-1 Receptor Antagonists; Animals; Area Under Curve; Drug Design; Half-Life; Humans; Indoles; Male; Prostatic Hyperplasia; Rats; Structure-Activity Relationship

Topics: Aged; Anticoagulants; Atrial Fibrillation; Heparin, Low-Molecular-Weight; Humans; Male; Perioperative Care; Postoperative Hemorrhage; Practice Guidelines as Topic; Prostatic Hyperplasia; Risk Assessment; Stroke; Thromboembolism; Transurethral Resection of Prostate; Warfarin

Intracerebral hemorrhage is a well-known complication resulting from warfarin use; however, warfarin-associated intraspinal hematoma is very rare. Warfarin-associated intraspinal hematoma may exhibit delayed progression, and patients may present with atypical symptoms, occasionally resulting in delayed diagnosis. We report the case of a 65-year-old man who visited our emergency department (ED) with acute urinary retention. He had been previously diagnosed with non-valvular atrial fibrillation, arterial hypertension, and benign prostatic hyperplasia, and he used warfarin for the prevention of systemic embolism. The patient was initially diagnosed with worsening of the prostatic hyperplasia. After 2 days, he revisited the ED with painless paraparesis. Magnetic resonance imaging of the thoracic spine revealed an intraspinal hematoma at Th7-8, and blood coagulation tests indicated a prothrombin time-international normalized ratio of 3.33. Despite attempts to reverse the effects of warfarin with vitamin K administration, the paraparesis progressed to paraplegia, necessitating urgent surgical removal of the hematoma. Partial recovery of motor function was evident after surgery. From the present case, we learned that intraspinal hematoma should be included in the differential diagnosis of patients using warfarin who present with acute urinary retention. Although there are no evidence-based treatment guidelines for warfarin-associated intraspinal hematoma, surgical treatment may be warranted for those who exhibit neurological deterioration.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Delayed Diagnosis; Diagnosis, Differential; Disease Progression; Hematoma, Epidural, Spinal; Humans; Hypertension; International Normalized Ratio; Male; Paraparesis; Prostatic Hyperplasia; Prothrombin Time; Recovery of Function; Urinary Retention; Warfarin

To evaluate current practice in the perioperative management of antiplatelets (AP) and anticoagulants (AC) among men undergoing elective transurethral resection of the prostate (TURP), as well as the associated perioperative bleeding and thromboembolic complications.. Retrospective review of consecutive elective TURP patients in a single tertiary institution from January 2011 to December 2013 (n = 293). Data on the regular use of AP/AC and the perioperative management approach were collected from patients' electronic medical records. Bleeding and thromboembolic complications were assessed up to 30 days postoperative. Association between AP/AC use and perioperative complications was assessed using the Kruskall-Wallis test (continuous variables) and the Fisher exact test (categoric variables).. There were 107/293 (37%) patients receiving long-term AP while there were 25/293 (9%) patients receiving long-term AC. A total of 72/107 (67%) patients ceased AP on an average of 7.6 days preoperatively, while 35/107 (33%) continued receiving AP. Patients with coronary stents (62%) and coronary bypass graft (67%) were significantly more likely to continued receiving AP (P < 0.001). AC was ceased in all patients preoperatively, with 16/25 (64%) receiving enoxaparin bridging. Overall, there were 31 (10%) incidents of bleeding complications and 5 (2%) thromboembolic events. AC users who had enoxaparin bridging had significantly higher risk of bleeding complications (44%), compared with non-AP/AC users (8%), AP users who ceased AP (4%), AP users who continued receiving AP (17%), and AC users who did not receive enoxaparin bridging (0%) (P < 0.001). AC users who received enoxaparin bridging also reported significantly higher thromboembolic complications (17%; P < 0.001) and prolonged hospital stay (mean 5.4 days) (P = 0.002), compared with other patients.. Perioperative management of AP/AC should be based on the indications and the American College of Chest Physicians thromboembolic risk stratification. Regular AC users who had enoxaparin bridging are at increased risk of both perioperative bleeding and thromboembolic complications.

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; Aspirin, Dipyridamole Drug Combination; Clopidogrel; Elective Surgical Procedures; Enoxaparin; Hemorrhage; Humans; Male; Middle Aged; Perioperative Care; Platelet Aggregation Inhibitors; Postoperative Complications; Prostate; Prostatic Hyperplasia; Retrospective Studies; Thromboembolism; Ticlopidine; Transurethral Resection of Prostate; Victoria; Warfarin; Withholding Treatment

To specifically evaluate perioperative morbidity associated with men who were taking coumadin and continued on this medication at therapeutic levels for the purposes of the prostate (PVP). Increasing numbers of men are taking coumadin for medical comorbidity and this creates clinical concerns for urologists treating such men with benign prostatic obstruction. Photoselective vaporization of the PVP has been shown to be an effective treatment for men receiving anticoagulation treatment, although previously published studies have evaluated a mix of men on aspirin, coumadin, or clopidogrel.. From a prospective database of men treated with the 120-W lithium triborate (LBO) laser from November 2006 to July 2010, 43 men were identified to have been on coumadin during their PVP. The mean age was 73.4 years (range, 55-90) and mean prostate size was 75.3 mL (range, 20-227). Perioperative morbidity and early functional outcomes were examined.. No men required a blood transfusion, although 2 of 43 (4.7%) men had prolonged catheterization for bleeding. No patient required discontinuation of the coumadin during the perioperative period. Urinary tract infection occurred in 4 (9.3%) and recatheterization in 6 (14%). Apart from 3 outliers, the mean postoperative length of stay was 21.6 hours. At 3 months, improvements in International Prostate Symptom Score, peak urinary flow rate, and postvoid residual were similar to previously reported series of men not taking an anticoagulant.. PVP in this high-risk group of patients has low perioperative morbidity and is associated with good early functional outcomes.

Topics: Aged; Aged, 80 and over; Anticoagulants; Humans; Laser Therapy; Male; Middle Aged; Postoperative Complications; Prospective Studies; Prostatectomy; Prostatic Hyperplasia; Warfarin

Topics: Anticoagulants; Humans; Laser Therapy; Male; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Warfarin

What's known on the subject? and What does the study add? There is controversy over the use of anti-platelet and anti-coagulant drugs in men undergoing TURP with contradictory evidence on the effect of the drugs on bleeding following the operation, particularly for aspirin. If anti-platelet or anti-coagulant drugs are not stopped for TURP, there is an unacceptable burden of bleeding. If the drugs are stopped there is an unacceptable rate of cardiovascular events.. • To determine the morbidity associated with perioperative management of antiplatelet (AP) or anticoagulant (AC) medication and transurethral prostatectomy.. • A retrospective review was performed on 163 consecutive patients undergoing transurethural prostatectomy. • Patients were grouped according to the perioperative management of AP and AC medications: control patients not prescribed any AP/AC drugs (group 1), those on AP/AC who had ceased them perioperatively (group 2) and those whose AP/AC were continued (group 3). • Warfarin was withheld perioperatively for all patients. • Morbidity associated with increased blood loss and cardiovascular or cerebrovascular events was recorded and differences were analysed with SPSS version 16 software.. • There was a statistically significant increase in bleeding-associated morbidity in group 2 (13/65) and group 3 (6/7) compared with the controls (9/91) (P < 0.01). • Cardiovascular and cerebrovascular events were only seen in group 2 (6/65), statistically significantly higher than the event rate in the other groups (P ≤ 0.01). • All cardiovascular or cerebrovascular events occurred in patients prescribed these medications for secondary prevention.. • Patients taking AP or AC medications have a higher rate of perioperative bleeding compared with those who are not taking any. • However, for patients prescribed AP or AC medication for secondary prevention, withholding these medications results in an increased rate of cardiovascular and cerebrovascular complications. • Careful consideration of the risks and other management options should be undertaken before performing transurethural prostatectomy in this high risk group of patients.

Topics: Aged; Anticoagulants; Aspirin; Blood Loss, Surgical; Cardiovascular Diseases; Case-Control Studies; Cerebrovascular Disorders; Humans; Male; Perioperative Care; Platelet Aggregation Inhibitors; Prostatic Hyperplasia; Prostatic Neoplasms; Retrospective Studies; Transurethral Resection of Prostate; Warfarin

Interstitial laser therapy (ILT) was performed without discontinuing warfarin anticoagulation therapy in eight patients (mean international normalized ratio 2.8 +/- 0.8) with benign prostatic hyperplasia. Three patients were in urinary retention and had failed voiding trials. Five had severe symptoms (mean American Urological Association symptom score 22 +/- 7) and had failed medical therapy.. Interstitial laser therapy was performed using the Indigo model 830e LaserOptic Treatment System with the patient under local anesthesia. Mean operative time was 25 minutes and mean total laser energy was 6,785 J.. After surgery, spontaneous voiding was achieved by 7 of the 8 patients at 1 week and by all 8 patients at 3 weeks. At 3-month follow-up, mean American Urological Association symptom score was 13 +/- 5, and mean peak urinary flow rate had increased to 12.2 +/- 3.2 mL/s from 8.8 mL/s (excluding retention) before surgery. Interstitial diode laser therapy appears to be a safe and effective technique for treatment of benign prostatic hyperplasia in the fully anticoagulated patient.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Follow-Up Studies; Heart Valve Prosthesis; Humans; Laser Therapy; Male; Middle Aged; Postoperative Period; Prostatic Hyperplasia; Pulmonary Embolism; Severity of Illness Index; Warfarin

The patient with marked bladder outlet obstructive symptoms who is taking anticoagulant medication presents a challenge to the urologist. This report consists of six such patients requiring full anticoagulation with oral warfarin. All patients were treated with the Surgical Laser Technologies neodymium: YAG contact laser using the sapphire tip, while they were fully anticoagulated. All patients had their catheters removed the morning following surgery, and were discharged that same morning. On follow-up all are voiding with excellent streams and have marked reduction in their bladder outlet obstructive symptoms. Contact laser vaporization of the prostate provides an efficient and cost-effective therapeutic option in the management of these high-risk patients.

Topics: Aged; Anticoagulants; Combined Modality Therapy; Contraindications; Cystoscopy; Heparin; Humans; Laser Therapy; Male; Middle Aged; Perioperative Care; Prostatectomy; Prostatic Hyperplasia; Treatment Outcome; Urinary Bladder Neck Obstruction; Warfarin

Since 1992, we have been performing VLAP using a right-angle laser delivery system (Urolase) for BPH patients with significant underlying nonurological diseases such as diabetes mellitus, cardiovascular, pulmonary, and malignant diseases. Sufficient clinical results have been obtained without major complications during short-term and long-term observation. In this study, we discuss the clinical advantages and safety of VLAP, compared with TURP, through analysis of the clinical procedure for VLAP for patients treated with anticoagulant agents such as warfarin. In our study of 40 patients, 8 patients were treated with anticoagulants for cardiovascular disease. During the procedure and after the operation, no significant complications were encountered except for transient postoperative bleeding. The 8 patients who received simultaneous anticoagulant therapy also underwent TURP to draw a comparison. The time taken for the procedure and the volume of the blood loss were significantly reduced by VLAP. The hemostatic nature of YAG laser energy seems to result in a technical improvement over conventional I URP for patients undergoing anticoagulant therapy.

Topics: Aged; Anticoagulants; Cardiovascular Diseases; Follow-Up Studies; Humans; Laser Therapy; Male; Postoperative Complications; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome; Warfarin

Transurethral laser ablation of the prostate gland was used to treat benign prostatic hyperplasia in 10 patients on warfarin anticoagulant therapy who had either significant clinical symptoms or who were in urinary retention. Anticoagulant therapy did not require alteration at any stage during treatment. All patients noticed improvements in symptom score assessments, flow rates and residual urine volumes following this procedure, and no significant complications were encountered. The hemostatic nature of neodymium:YAG laser energy as applied in this procedure appears to result in a technical improvement upon conventional transurethral resection for the treatment of symptomatic benign prostatic hyperplasia in patients taking warfarin anticoagulant therapy.

Topics: Aged; Aged, 80 and over; Catheter Ablation; Follow-Up Studies; Humans; Laser Therapy; Male; Middle Aged; Prospective Studies; Prostatic Hyperplasia; Urethra; Warfarin

Three patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia underwent laser prostatectomy using a Neodymium:YAG source delivered with the Urolase right-angle laser fiber. All patients had significant underlying medical problems, and all were fully anticoagulated with oral warfarin (mean prothrombin time 17 seconds). Two were in urinary retention with indwelling catheters preoperatively. Laser prostatectomy was performed in each case without change in the medical regimen, including continuous warfarin dosing. No complications occurred, and in particular, no early or late bleeding episodes were encountered. All are symptomatically improved and catheter-free on follow-up. Laser prostatectomy provides a new and safe therapeutic option in the management of these high-risk patients.

Topics: Aged; Aged, 80 and over; Humans; Laser Therapy; Male; Middle Aged; Prostatectomy; Prostatic Hyperplasia; Urinary Bladder Neck Obstruction; Warfarin

To explore mechanisms of coagulation activation in adenocarcinoma of the prostate, the occurrence and distribution of components of coagulation and fibrinolysis pathways in situ were studied by means of immunohistochemical techniques applied to frozen sections of fresh malignant and benign hyperplastic prostatic tissue obtained at transurethral resection. Fibrinogen was distributed throughout the perivascular and tumor connective tissue in both malignant and benign disease but was not present in adjacent areas of normal prostate. Antibodies specific for fibrin and D-dimer crosslink sites stained vascular endothelium focally in both malignant and benign tissues. Both neoplastic cells and benign hyperplastic glandular epithelial cells stained weakly and in a patchy distribution for tissue factor and focally for low-molecular-weight urokinase-type plasminogen activator. Focal staining of vascular endothelium was also observed for tissue plasminogen activator and plasmin-antiplasmin complex neoantigen. By contrast, no tissue staining was observed for factor VII, factor X, factor XIII "a" subunit, high-molecular-weight urokinase-type plasminogen activator, plasminogen activator inhibitors 1 to 3, protein C, and protein S. Thus, the similarity in findings between benign hyperplastic and neoplastic prostate tissue, the lack of either an intact tumor cell-associated coagulation pathway or fibrin formation, and the presence of fibrin on vascular endothelium are consistent with the concept that coagulation activation in prostatic cancer may not be due to a direct effect of the tumor cells on the clotting mechanism. Rather, such activation may be induced by a soluble tumor product that activates procoagulant activity on certain host (for example, vascular endothelial) cells. These findings, together with the lack of effect of warfarin anticoagulation on the clinical course of patients with prostatic cancer, contrast with findings in certain other tumor types and suggest that coagulation activation may not contribute to progression of adenocarcinoma of the prostate.

Topics: Antibodies, Monoclonal; Endothelium, Vascular; Fibrin; Fibrinogen; Humans; Male; Molecular Weight; Plasminogen Activators; Prostatic Hyperplasia; Prostatic Neoplasms; Survival Rate; Thromboplastin; Warfarin