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Perioperative outcomes of ongoing antithrombotic therapy during endoscopic surgery for benign prostatic hyperplasia: a systematic review and meta-analysis of observational studies

Prostate Cancer and Prostatic Diseases (2026)Cite this article

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Abstract

Background

The management of antithrombotic therapy in patients undergoing endoscopic surgery for benign prostatic hyperplasia (BPH) remains challenging due to competing risks of thromboembolism and perioperative bleeding. This meta-analysis evaluated perioperative outcomes among patients undergoing endoscopic prostate procedures while continuing antiplatelet (APT) or anticoagulant (AC) therapy compared with patients not receiving antithrombotic treatment.

Methods

Literature search was conducted on 17th September 2025 including PubMed, Medline, Embase, and Scopus database, to identify comparative studies evaluating perioperative outcomes of endoscopic prostate procedures in patients on versus off APT/AC therapy were identified. Data were pooled using random-effects models to estimate mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI).

Results

Fifteen studies comprising 6091 patients (1900 on APT/AC, 4191 controls) were included. Operative time, postoperative hemoglobin decrease, catheterization duration, and continuous bladder irrigation time were comparable between groups across all surgical modalities. However, bleeding-related complications were significantly more frequent among APT/AC users undergoing transurethral resection of the prostate (TURP) (OR 1.90, 95% CI 1.05–3.41, p = 0.03) and enucleation (OR 2.91, 95% CI 1.71–4.93, p < 0.0001), particularly in the AC subgroup (OR 4.80, p = 0.0002). Enucleation also carried higher odds of bleeding requiring surgical hemostasis (OR 3.69, 95% CI 1.73–7.84, p = 0.0007) and acute urinary retention (OR 1.36, 95% CI 1.04–1.77, p = 0.02) among antithrombotic users. Conversely, photoselective vaporization (PVP) demonstrated comparable rates of transfusion, hemostasis, and urinary complications regardless of APT/AC therapy. Hospital stay was marginally longer after TURP and PVP among APT/AC users (p < 0.05).

Conclusions

Continuation of antithrombotic therapy during PVP appears safe, with perioperative outcomes comparable to those of non-antithrombotic patients. Conversely, its ongoing use—especially AC—significantly increases bleeding risks following TURP and enucleation. PVP may therefore represent the preferred modality for high-risk patients requiring uninterrupted antithrombotic therapy. Clinical decision-making should balance individual thromboembolic risk against anticipated bleeding risk, with multidisciplinary input when appropriate.

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Fig. 1
Fig. 2: Studies concerning Acute Urinary Retention.
Fig. 3: Studies concerning Blood Transfusion.
Fig. 4: Studies concerning Bleeding Requiring Surgical Haemostasis.
Fig. 5
Fig. 6: Studies concerning Operative Time.
Fig. 7: Studies concerning 1-day postoperative Change in Haemoglobin.
Fig. 8: Studies concerning the Continuous bladder washout duration.
Fig. 9: Studies concerning Hospital Stay.
Fig. 10: Studies concerning Length of catheterization.

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Data availability

The dataset used in this study is available upon request from the corresponding author.

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Authors and Affiliations

  1. Department of Urology, Casa di Cura Villa Igea, Ancona, Italy

    Carlo Giulioni, Angelo Cafarelli, Federico Falsetti & Luca Spinozzi

  2. Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy

    Angelo Cormio

  3. Department of Urology, IRCCS San Gerardo dei Tintori, Monza, Italy

    Carlotta Nedbal

  4. Internal Medicine Unit Jesi, Area Vasta 2 ASUR Marche, Jesi, Italy

    Valentina Maurizi

  5. S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China

    Steffi Kar Kei Yuen

  6. Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore

    Vineet Gauhar

  7. Department of Urology, C.Ur.E.—Centro Urologico Europeo, Hesperia Hospital, Modena, Italy

    Luca Cindolo

  8. UniCamillus—Saint Camillus International University of Health and Medical Sciences, Rome, Italy

    Michele Marchioni & Luigi Schips

  9. Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy

    Daniele Castellani

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Contributions

CG: project development, manuscript writing, analysis, data collection, AC: project development. FF: Data collection and analysis. LSp: Data collection. AC: Data collection. CN: Data Analysis. VM: Manuscript editing. SKKY: Data analysis and Manuscript Editing. VG: Manuscript Writing. LC: Manuscript editing. MM: Manuscript editing. LSc: Manuscript editing. DC: Project development and manuscript editing.

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Correspondence to Carlo Giulioni.

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Giulioni, C., Cafarelli, A., Falsetti, F. et al. Perioperative outcomes of ongoing antithrombotic therapy during endoscopic surgery for benign prostatic hyperplasia: a systematic review and meta-analysis of observational studies. Prostate Cancer Prostatic Dis (2026). https://doi.org/10.1038/s41391-026-01098-4

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