What urological treatments are possible in hemophilic patients?

Objective : Urological procedures are hazardous for hemophilic patients, Th e aim of this work is to report the treatment of 22 hemophilic patients in order to define prognosis factors and treatment options. Material and Methods : 22 patients have been treated : 8 had severe hemophi lia, 5 A (FVIII <1%), 3 B (F IX <1%), 2 had moderate hemophilia A (FVIII 2 to 6%) and 10 minor hemophilia A (F VIII 7 to 30%). Two had acquired hemoph ilia with auto-anti-FVIII antibodies (ab). Four patients were HIV+. Eightee n patients were first referred to our hospital, and 3 were transferred from an other institution for persistent hematuria : one with anuria, one after bladder neck incision, and the other following suprapubic prostatectomy. Results : For patients without FVIII ab, a sufficient level of FVIII or IX (>60%), could be achieved pre-operatively and maintained post operatively ( 4 to 20 days, according to the surgical procedure) by injections of FVIII, FIX or by injections of desmopressin. For one haemophilia A patient with anti-F VIII ab, transferred for uncontro llable bleeding after bladder neck incision, selective arterial embolizatio n was successful. But for 2 patients with acquired haemophilia, improvement of the coagulatio n was insufficient, with human or porcine FVIII, activated prothombic compl ex concentrates or recombinant activated FVII. In spite of surgical procedu res and arterial embolizations the 2 patients died. Conclusion : The urological treatment of haemophilic patients needs to be p erformed in specialised centers. For patients without FVIII ab, classical u rological procedures can be performed But for patients with FVIII ab when a lternative treatments (radiotherapy, LNRH agonist) can be used, the surgica l procedures must be delayed; in emergency if hemostasis cannot be achieved arterial embolization could be useful.