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MP45-14 RETROSPECTIVE ANALYSIS OF BLOOD LOSS OUTCOMES DURING 10-YEAR EXPERIENCE WITH HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) FOR BENIGN PROSTATIC HYPERPLASIA.

INTRODUCTION AND OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) was developed as an effective and minimally invasive alternative to traditional surgical techniques. Since its introduction in the late 1990s, HoLEP has shown equal or better outcomes than TURP or OP, with a lower risk of intraoperative bleeding and blood transfusion. These results have been confirmed in patients receiving anticoagulant/antithrombotic therapy. However, due to the prolonged learning curve of the technique, HoLEP has barely entered the urological community, thus limiting the data available on the daily use of this technique. One of the unmet needs regarding the use of HoLEP for BPH is the identification of factors influencing intraoperative blood loss. The objective of this work is to assess blood loss during holmium laser enucleation of the prostate (HoLEP) and investigate the factors influencing it. METHODS: Retrospective analysis of patients with benign prostatic hyperplasia (BPH) treated with HoLEP at three centres. Haemoglobin and haematocrit were measured before surgery and hospital discharge. All blood transfusions performed during and after HoLEP were recorded. Blood loss outcomes were analysed in relation to antithrombotic (antiplatelet/anticoagulant) therapies and drug treatments for BPH. RESULTS: The analysis included 963 patients with a mean age of 72 years. Mean (range) prostate size was 102 (40-316) g; 28% of patients were receiving antiaggregants and 11% anticoagulants. Mean (range) prostate-specific antigen was 6.0 (0.3-43.5) ng/dL. Mean (range) operation time was 77 (28-178) min. Bladder calculi were found in 54 (5.6%) patients; all of them were successfully treated with cystolitholapaxy. Forty-eight (5%) patients required blood transfusion during or immediately after the HoLEP procedure. Overall, mean (SD) haemoglobin decreased from 14.6 (1.5) g/dL to 12.3 (2.1) g/dL (p<0.001), and mean (SD) haematocrit decreased from 44.3% (4.7) to 37.7% (6.5) (p<0.001). Neither haemoglobin nor haematocrit decreases were significantly different between patients receiving and not receiving antithrombotic therapy or BPH therapy. CONCLUSIONS: HoLEP is a safe procedure with no remarkable concerns regarding blood loss, including patients at high risk, such as those receiving antithrombotic therapy. Operating time may influence haemoglobin decrease and, therefore, it should be considered in patients with higher risk of bleeding. Source of Funding: none