To evaluate the safety and clinical efficacy of photoselective vaporesection of the prostate treatment in high-risk elderly patients with benign prostatic hyperplasia (BPH) who are on oral anticoagulant therapy during the perioperative period.

A total of 116 elderly patients clinically diagnosed with benign prostatic hyperplasia who were admitted to Huaibei People's Hospital from September 2021 to September 2024 were included. They were divided into the oral anticoagulant group (OA group, n=45) and the non-anticoagulant group (non-OA group, n=71) based on whether they took oral anticoagulant drugs before the operation. The operation time, pre- and postoperative haemoglobin changes, bladder irrigation time and indwelling catheter time, postoperative hospital stay, IPSS, QOL, Q_max, PVR and postoperative complications at 1, 3 and 6 months before and after operation were observed in the two groups.

The incidence of postoperative complications in the two groups was 17.8% (OA group) and 12.7% (non-OA group), respectively, with no significant difference between the two groups (P>0.05). The operation time in the OA group [(68.8±9.5) min] was longer than that in the non-OA group [(59.2±5.5) min], which was a significant difference (P<0.001). The duration of continuous postoperative bladder irrigation in the OA group [(24.8±2.2) h] was longer than that of the non-OA group [(24.2±2.6) h], with no significant difference (P>0.05). The postoperative catheter retention time in the OA group [(4.7±0.8) d] was longer than that in the non-OA group [(4.5±0.5) d], and the difference was statistically significant (P=0.043). The decrease in haemoglobin in the OA group and the non-OA group after the surgery was (9.8±3.4) g/L and (9.3±2.7)g/L respectively, and the difference between the two groups was not statistically significant (P>0.05). The length of postoperative hospital stay in the OA group [(5.5±0.7) d] was longer than that in the non-OA group [(5.3±0.5) d], and the difference was not statistically significant (P>0.05). The patients in the two groups at 1, 3, and 6 months after the surgery had a significant improvement in the IPSS, QOL, Q_max, and PVR compared with that of preoperative period and the difference was statistically significant (P<0.05), the differences in IPSS, QOL, Q_max and PVR between the two groups were not statistically significant (P>0.05).

Photoselective vaporesection of the prostate may be an effective and safe way for the treatment of perioperative maintenance of oral anticoagulants in elderly patients with high-risk prostatic hyperplasia.