Introduction and Objective: Holmium laser enucleation of the prostate (HoLEP) is often offered for symptomatic prostatic enlargement at high risk for bleeding. However, prior studies define clinically significant hematuria (CSH) narrowly as the need for blood transfusion or significant decrease in hemoglobin. We sought to evaluate risk factors contributing to a broader definition of CSH, which may contribute to alteration of clinical course. Methods: We analyzed 164 patients in a prospectively maintained database who underwent HoLEP at a single institution across two surgeons from November 2020 to April 2023. HoLEP was performed using Moses 2.0 (Boston Scientific) laser and the Piranha enucleation system (Richard Wolf). We defined CSH broadly as follows: clot retention, return to operating room, perioperative management variation due to hematuria, or continued gross hematuria past 1 month postoperatively. Univariable and multivariable ANOVAs were used. Multivariable analysis of CSH risk based on the use of antiplatelet (AP) agents or anticoagulants included correction for age, enucleation time (surrogate for case difficulty), and prostate volume. Results: 17.7% (29/164) of our patients developed CSH after HoLEP. Longer enucleation time was a mild risk factor for developing CSH (multivariate odds ratio [OR] 1.01, p = 0.02). The strongest predictor of CSH was the use of anticoagulation or AP agents (OR 2.71 p < 0.02 on univariable analysis, OR 2.34 p < 0.02 on multivariable analysis), even when aspirin 81 mg was excluded. Conclusion: With a broadened definition, 18% of patients developed CSH following HoLEP, which impacted the clinical course. Our data suggest that the current definition of significant hematuria is too narrow and does not capture many patients whose clinical course is affected by hematuria. While safe, anticoagulants and APs significantly predicted an increased CSH risk, and patients should be counseled accordingly.

中文翻译：

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重新定义钬前列腺剜除术后临床上显着的血尿。

简介和目的：钬激光前列腺剜除术（HoLEP）通常用于治疗出血风险高的有症状的前列腺肥大。然而，先前的研究将临床显着血尿（CSH）狭义地定义为需要输血或血红蛋白显着下降。我们试图评估有助于更广泛 CSH 定义的风险因素，这可能有助于改变临床病程。方法：我们分析了前瞻性维护的数据库中的 164 名患者，这些患者从 2020 年 11 月至 2023 年 4 月在同一机构的两名外科医生接受了 HoLEP。HoLEP 使用 Moses 2.0 (Boston Scientific) 激光和 Piranha 剜除系统 (Richard Wolf) 进行。我们对 CSH 的大致定义如下：凝块滞留、返回手术室、血尿导致的围手术期管理变化或术后 1 个月内持续出现肉眼血尿。使用单变量和多变量方差分析。基于使用抗血小板 (AP) 药物或抗凝剂的 CSH 风险的多变量分析包括年龄、摘除时间（替代病例难度）和前列腺体积的校正。结果：HoLEP 后 17.7% (29/164) 的患者出现 CSH。较长的摘除时间是发生 CSH 的轻度危险因素（多变量优势比 [OR] 1.01，p = 0.02）。CSH 最强的预测因素是抗凝或 AP 药物的使用（单变量分析中 OR 2.71 p < 0.02，多变量分析中 OR 2.34 p < 0.02），即使排除阿司匹林 81 mg 也是如此。结论：随着定义的扩大，HoLEP 后 18% 的患者出现 CSH，这影响了临床病程。我们的数据表明，目前显着血尿的定义过于狭窄，并未涵盖许多临床病程受血尿影响的患者。虽然安全，但抗凝剂和 AP 显着预测 CSH 风险增加，因此应向患者提供相应的咨询。