Congenital Haemostasis Disorders and Urology Surgery: Is It Safe?

TL;DR

This study examines the safety of urology surgery in patients with bleeding disorders like hemophilia and von Willebrand disease.

Contribution

The study provides insights into the risks of bleeding and complications during urology procedures in patients with congenital hemostasis disorders.

Findings

Patients with bleeding disorders had a longer hospital stay and higher bleeding event rates compared to controls.

Use of electrocoagulation was associated with increased readmission and transfusion rates in these patients.

Bleeding disorders were linked to a 21% incidence of bleeding events versus 2% in controls.

Abstract

Background: There are no specific recommendations for the management of patients with bleeding disorders (BD), such as haemophilia A (HA), haemophilia B (HB), or von Willebrand disease (WD), in urology surgery. Methods: We conducted a retrospective study of 32 patients with HA, HB, or WD of any severity. Fifty-seven procedures were performed between January 2017 and September 2023. Surgical interventions were divided into two groups: those with and without electrocoagulation. The control patients were successively matched in a 2:1 ratio. Results: The study group consisted of 30 men and 2 women, with 23 HA, 2 HB, and 7 WD. The median age of the patients was 69 years. The BD group had a longer hospital stay of 4 days compared to 1 day (p < 0.0001). The incidence of bleeding events was 21% versus 2% (p < 0.0001), and the incidence of complications was 21% versus 7% (p = 0.0036) for Clavien 1–2 respectively. In the subgroup with intraoperative coagulation, the readmission rate at 30 days was higher (17% vs. 3%, p = 0.00386), as was the transfusion rate (17% vs. 3%, p = 0.0386). Conclusions: This study showed that urological procedures in patients with bleeding disorders were associated with a higher risk of bleeding and complications.