Risk factors for delayed hematuria following photoselective vaporization of the prostate

Abstract

Purpose: Photoselective vaporization of the prostate has become an increasingly popular option for the treatment of benign prostatic hyperplasia. However, delayed bleeding has been raised as a potential issue as more cases are performed. We characterize delayed bleeding after photoselective vaporization of the prostate and identify associated risk factors.

Materials and methods: We defined delayed gross hematuria as any complaint of hematuria following hospital discharge, and further stratified it as delayed gross hematuria requiring emergency department evaluation, hospital admission, continuous bladder irrigation, transfusions or reoperation. We performed an explicit chart review of 290 patients who underwent photoselective vaporization of the prostate at a single center from 2002 through 2009. Exposures of interest included age, prostate volume, followup duration, operative factors (watts/joules), and use of oral anticoagulation therapy or 5α-reductase inhibitors.

Results: Delayed gross hematuria occurred in 33.8% of patients during an average followup of 33 months. For 8.5% of patients the bleeding was severe enough to prompt presentation to the emergency department. For 4.8% of patients hospitalization was required and for 4.5% reoperation was required. Multivariate analysis revealed that the odds of bleeding increased with prostate size (OR 1.08, 1.03-1.14), longer followup (OR 1.35, 1.12-1.62) and anticoagulant use (OR 3.35, 1.43-7.83), and decreased with increasing age (OR 0.71, 0.51-0.98) and use of a 5α-reductase inhibitor (OR 0.41, 0.24-0.73).

Conclusions: Delayed hematuria occurs commonly after photoselective vaporization of the prostate but severe hematuria is rare. Larger prostate size, longer followup and use of anticoagulation were associated with a higher risk of delayed gross hematuria while preoperative 5α-reductase inhibitor use and older age were protective.

Keywords: 5ARI; 5α-reductase inhibitor; CBI; DH; ED; ER; PVP; TRUS; TURP; anticoagulants; continuous bladder irrigation; delayed gross hematuria; emergency department; emergency room; lasers; photoselective vaporization of the prostate; prostate; prostatic hyperplasia; transrectal ultrasound; transurethral resection of the prostate; urination disorders.