Of the 337 patients who took AT, 24.6% (n = 83) received AP while 15.1% (n = 51) received AC therapy. The preoperative characteristics of the 337 study patients were not statistically different between groups except age (p=0.015) and ASA score. Patients with AP and AC showed more comorbidities (higher ASA status, p<0.001) (Table 1). In the AP group, history showed coronary heart disease in 56 patients (67.5%), cerebrovascular accident in 8 (9.6%), peripheral arterial occlusive disease in 9 (10.8%), and other reasons (primary prevention for coronary artery disease) in 10 (12.1%). Of the patients who received AC, 21 (41.2%) had chronic atrial fibrillation, 12 (23.5%) had a cerebrovascular event, 8 (15.7%) had a prosthetic heart valve, 5 (9.8%) had a pulmonary embolism, 3 (5.9%) had a vascular prosthesis, and 2 (3.9%) had deep vein thrombosis.

Perioperative outcomes did not show major differences in terms of AT. Median time of enucleation and morcellation were 46 min (IQR:15-120, p=0.548) and 15 min (IQR:4-60, p=0.168), enucleation and morcellation efficiency were 1.58 (IQR:0.87-3.13, p=0.115) and 5 (IQR:1-8.08, p=0.204), respectively. There was no difference between the three groups in terms of hemoglobin decrease within 12 hours (perioperatively) and 1-week postoperatively (p=0.225 and p=0.545, respectively) (Table 2). In the present study, all patients underwent HoLEP safely without any adverse TE within 3 months postoperatively.

In three groups, International Prostate Symptom Scores (IPSS), postvoiding residual volume (PVR), and QoL score significantly decreased and maximum flow rates (Qmax) significantly increased postoperatively compared with the preoperative values (p<0.001) (Fig. 1A-D). Three months after surgery, these functional results had improved significantly in all groups with no differences between the groups.

The median time of catheterization was 2 days (IQR: 2–3). The prolonged catheterization occurring in 36 (10.7%) patients. A statistical difference was found between the three groups for prolonged catheterization (p=0.028). Also, the AP and AC groups were compared with the NT group in terms of prolonged catheterization (AP vs NT; OR: 2.77, 95% CI: 1.28-5.96, p=0.007 and AC vs NT; OR: 1.67, 95% CI:0.61-4.55, p=0.391). Overall, one (1.2%) patient in the AP group required blood transfusion on 4 days postoperatively due to clot retention and significant hemoglobin decrease (p = 0.216). The patient was catheterized and the clot was evacuated without the need for an operation. The AP and NT groups were compared for blood transfusion and clot retention, no statistically significant difference was found (AP vs NT; OR: 1.012, 95% CI: 0.988–1.037, p=0.29).