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A review study to evaluate holmium:YAG laser lithotripsy with flexible ureteroscopy in patients on ongoing oral anticoagulant therapy.
Lasers Med Sci. 2017 Sep; 32(7):1615-1619.LM

Abstract

The objective of this study was to evaluate the safety and efficacy of flexible ureteroscopy (FURS) and holmium:YAG laser lithotripsy for the treatment of upper urinary tract stones in patients on active oral anticoagulants. The records of 1081 patients who underwent flexible ureteroscopic holmium:YAG (Ho:YAG) laser lithotripsy for upper ureteral and renal calculi from 1999 to 2015 were retrospectively reviewed. A total of 84 patients on continuous oral anticoagulation or antiplatelet therapy (warfarin, aspirin, or clopidogrel) were identified. Of these patients, 40 were on warfarin, 25 on aspirin, 11 on clopidogrel, and 8 on both aspirin and clopidogrel. The drugs were not discontinued. The baseline characteristics, indications for anticoagulation therapy, perioperative data, stone-free rate, and complications were documented. Evaluation of outcomes was assessed at 1-, 3-, and 6-month follow-up postoperatively. Mean stone size was 19.7 ± 9.4 (range 8 to 31 mm). Twenty patients had upper ureteral and 64 patients had intrarenal calculi. Two patients had bilateral renal calculi. Mean operation time was 78.2 ± 23.8 min (range 17 to 144 min). Two procedures (2.3%) in warfarin group were terminated due to persistent bleeding causing visual impairment. No transfusions were required. The mean serum hemoglobin levels did not change significantly (12.9 ± 3.7 to 12.2 ± 3.3 g/dL). No thromboembolic or cardiac adverse events were observed perioperatively. The double-j (DJ) ureteral catheterization time was 29.6 ± 9.3 days (range 14 to 68 days) and the hospital stay was 1.6 ± 0.6 days (range 1 to 4). The stone-free rate was 95.2% (80 patients) at 6 months. Flexible ureteroscopic Ho:YAG laser lithotripsy in patients requiring long-term anticoagulation therapy seems to be a safe and effective procedure and should be considered as a first-line treatment option in such patients for the surgical management of upper urinary tract stones.

Authors+Show Affiliations

Department of Urology, Istanbul Medipol University, 34718, Istanbul, Turkey. baltay@medipol.edu.tr.Department of Urology, Istanbul Medipol University, 34718, Istanbul, Turkey.Department of Urology, Istanbul Medipol University, 34718, Istanbul, Turkey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28733910

Citation

Altay, Bulent, et al. "A Review Study to Evaluate holmium:YAG Laser Lithotripsy With Flexible Ureteroscopy in Patients On Ongoing Oral Anticoagulant Therapy." Lasers in Medical Science, vol. 32, no. 7, 2017, pp. 1615-1619.
Altay B, Erkurt B, Albayrak S. A review study to evaluate holmium:YAG laser lithotripsy with flexible ureteroscopy in patients on ongoing oral anticoagulant therapy. Lasers Med Sci. 2017;32(7):1615-1619.
Altay, B., Erkurt, B., & Albayrak, S. (2017). A review study to evaluate holmium:YAG laser lithotripsy with flexible ureteroscopy in patients on ongoing oral anticoagulant therapy. Lasers in Medical Science, 32(7), 1615-1619. https://doi.org/10.1007/s10103-017-2289-4
Altay B, Erkurt B, Albayrak S. A Review Study to Evaluate holmium:YAG Laser Lithotripsy With Flexible Ureteroscopy in Patients On Ongoing Oral Anticoagulant Therapy. Lasers Med Sci. 2017;32(7):1615-1619. PubMed PMID: 28733910.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A review study to evaluate holmium:YAG laser lithotripsy with flexible ureteroscopy in patients on ongoing oral anticoagulant therapy. AU - Altay,Bulent, AU - Erkurt,Bulent, AU - Albayrak,Selami, Y1 - 2017/07/22/ PY - 2016/06/10/received PY - 2017/07/13/accepted PY - 2017/7/25/pubmed PY - 2018/2/24/medline PY - 2017/7/23/entrez KW - Flexible ureteroscopy KW - Ho:YAG laser KW - Kidney stone KW - Oral anticoagulants SP - 1615 EP - 1619 JF - Lasers in medical science JO - Lasers Med Sci VL - 32 IS - 7 N2 - The objective of this study was to evaluate the safety and efficacy of flexible ureteroscopy (FURS) and holmium:YAG laser lithotripsy for the treatment of upper urinary tract stones in patients on active oral anticoagulants. The records of 1081 patients who underwent flexible ureteroscopic holmium:YAG (Ho:YAG) laser lithotripsy for upper ureteral and renal calculi from 1999 to 2015 were retrospectively reviewed. A total of 84 patients on continuous oral anticoagulation or antiplatelet therapy (warfarin, aspirin, or clopidogrel) were identified. Of these patients, 40 were on warfarin, 25 on aspirin, 11 on clopidogrel, and 8 on both aspirin and clopidogrel. The drugs were not discontinued. The baseline characteristics, indications for anticoagulation therapy, perioperative data, stone-free rate, and complications were documented. Evaluation of outcomes was assessed at 1-, 3-, and 6-month follow-up postoperatively. Mean stone size was 19.7 ± 9.4 (range 8 to 31 mm). Twenty patients had upper ureteral and 64 patients had intrarenal calculi. Two patients had bilateral renal calculi. Mean operation time was 78.2 ± 23.8 min (range 17 to 144 min). Two procedures (2.3%) in warfarin group were terminated due to persistent bleeding causing visual impairment. No transfusions were required. The mean serum hemoglobin levels did not change significantly (12.9 ± 3.7 to 12.2 ± 3.3 g/dL). No thromboembolic or cardiac adverse events were observed perioperatively. The double-j (DJ) ureteral catheterization time was 29.6 ± 9.3 days (range 14 to 68 days) and the hospital stay was 1.6 ± 0.6 days (range 1 to 4). The stone-free rate was 95.2% (80 patients) at 6 months. Flexible ureteroscopic Ho:YAG laser lithotripsy in patients requiring long-term anticoagulation therapy seems to be a safe and effective procedure and should be considered as a first-line treatment option in such patients for the surgical management of upper urinary tract stones. SN - 1435-604X UR - https://www.unboundmedicine.com/medline/citation/28733910/A_review_study_to_evaluate_holmium:YAG_laser_lithotripsy_with_flexible_ureteroscopy_in_patients_on_ongoing_oral_anticoagulant_therapy_ L2 - https://dx.doi.org/10.1007/s10103-017-2289-4 DB - PRIME DP - Unbound Medicine ER -