Holmium Laser Enucleation of the Prostate in Patients on Anticoagulant Therapy or With Bleeding Disorders
Why this work is in the frame
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Bibliographic record
Abstract
PURPOSE: We evaluated the safety and efficacy of HoLEP in patients on anticoagulation with significant obstructive symptoms secondary to BPH refractory to medical therapy. MATERIALS AND METHODS: From May 1999 to October 2004, 83 patients with a mean age of 76.6 years who had symptomatic BPH and were on chronic oral anticoagulant therapy or had bleeding disorders underwent HoLEP. Mean preoperative prostate size estimated by transrectal ultrasound was 82.4 cc (range 25 to 222). A total of 14 patients underwent HoLEP without oral anticoagulant withdrawal, 34 underwent surgery with low molecular weight heparin substitution and 33 stopped anticoagulants before surgery, including 8 on antiplatelet therapy. All patients were assessed preoperatively, and 1, 3, 6 and 12 months after surgery. RESULTS: HoLEP was performed successfully in all patients with a mean enucleation time of 86.5 minutes (range 35 to 210). Mean morcellation time was 20.1 minutes (range 3 to 100). Peak urinary flow, post-void residual urine, International Prostate Symptom Score and quality of life score were significantly improved by 1 month after surgery and they continued to improve during subsequent followup. One patient required intraoperative platelet transfusion and 7 required blood transfusion early in the postoperative period due to hematuria coinciding with restarting oral anticoagulant therapy. Mean preoperative and postoperative hemoglobin was 13.5 (range 8.3 to 16.4) and 12.2 gm/dl (range 5.3 to15.4), respectively (p <0.0001). There were no major operative or postoperative complications, or thromboembolic events. CONCLUSIONS: HoLEP is a safe and effective therapeutic modality in patients on anticoagulation with symptomatic BPH refractory to medical therapy.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it