Laser treatment of BPH with local anaesthesia and hypnosis in high risk patients

1. No. 047 Laser treatment of BPH with local anaesthesia and hypnosis in high risk patients R. Thanigasalam, A. Hajj, M. Fourati, W. Massoud, P-E. Theveniaud, F.Girard, O. Dumonceau, H.Baumert Department of Urology, GroupeHospitalier Paris Saint-Joseph, Paris 75014, France Posters Proudly Supported by: Introduction Elderly patients with multiple co- morbidities taking anticoagulant therapy that preclude them from GA/Spinal Anaesthesia present unique challenges when being considered for surgical treatment of BPH. These pts are becoming more common in urological practice, due to the ageing population. They are at a potentially increased risk of complications related to general anaesthesia and bleeding. An alternative option in high risk patients is to perform laser surgery for the treatment of BPH with local anaesthesia and hypnosis. Results Good functional results were achieved at 3 months with the mean urinary flow rate of 12mls/sec in 10 of the 12 patients operated on under local anesthesia (All patients had a pre-op flow rate of 0mls/sec due to having an IDC at the time of surgery) 2 patients had unsuccessful trial of voids. The first needed a further resection under spinal anesthesia, after 6 weeks. The second patient was permanently catheter dependent. No secondary bleeding needing inpatient hospitalization occurred. Post-operative Mean pain score : 3/10 Median Patient Satisfaction score: 8/10 Aim We present our experience of Laser Prostate Vaporization (LPV) and Transurethral Incision of the Prostate using laser (TUIP) under local anesthesia and hypnosis in a French Tertiary referral centre. Methods Between January 2007 & May 2012: LPV was indicated in 7 patients and TUIP in 5 patients who took anticoagulant or anti-platelet treatment. The mean age of patients in the series was 82 (64-95). All patients continued on Anticoagulant or anti-platelet treatment at the time of surgery. In all patients the ASA score was 3. 10 patients had an indwelling catheter, 3 had a supra-pubic catheter before surgery. The mean size of the prostate was 35 grams (range: 15-75). At the beginning of the procedure local anesthesia with xylocaine gel was instilled, then hypnosis was performed by a specially trained anaesthetist. A thulium (Rivolix) laser system was used with the fibre introduced via a double channel cystoscope and the procedure (LPV or TUIP depending on the anatomy) was performed. Conclusions Laser Prostate Vaporization or Transurethral Incision of the Prostate using laser under local anesthesiaand hypnosis is a viable alternative to treat BPH in patients with multiple co-morbidities taking anticoagulant therapy that preclude them from GA/Spinal Anaesthesia . Acknowledgements Dr Michelle Ceddaha, Department of Anaesthetics, GroupeHospitalier Paris Saint Joseph, Paris, France