The characteristics of post tur blood loss: a preliminary study

Is routine post-operative haemoglobin measurement required after transurethral resection of the prostate?

The aim of this study is to evaluate the rate of blood transfusion during the post-operative period in patients undergoing transurethral resection of the prostate (TURP) and to determine the value of using post-operative haemoglobin (Hb) measurement as a guide to transfusion requirements. In a retrospective study, pre- and post-operative Hb measurements and the resected prostatic tissue weights were recorded for 106 patients. There was a statistically significant change in the Hb concentration within 48 h of the operation (P < 0.0001), although this was clinically insignificant in the majority of patients. The post-operative blood transfusion rate was 0.85% and there was a significant correlation between change in Hb concentration and the resected tissue weight (P < 0.0001). Our results show that routine post-operative Hb is not necessary in patients following a TURP.

Haematuria and clot retention after transurethral resection of the prostate: a pilot study

OBJECTIVE

To determine, prospectively, the effect of clinical factors on the duration of frank haematuria and the incidence of clot retention after transurethral resection of the prostate (TURP).

PATIENTS AND METHODS

Seventy-nine men who underwent TURP in a 3-month period were entered into this study, during which the time to cessation of bleeding and the occurrence of clot retention(s) were recorded over a 4-week period. The effect of other clinical factors (histology, weight of tissue resected. operative duration, grade of surgeon and resection rate) was also assessed.

RESULTS

Gross haematuria ceased in 47%, 73%, 96%, and 97% of patients at the end of the first, second, third and fourth weeks, respectively. The duration of postoperative bleeding was significantly associated with the weight of tissue resected and the operation time (P<0.001 and <0.05, respectively). Furthermore, five patients were re-admitted with clot retention, but there was no significant correlation between the occurrence of this morbidity and any of the other indices.

CONCLUSION

Postoperative bleeding usually stops within 3 weeks of TURP. This period, which is about half the time hitherto assumed, is directly related to the size of the gland resected and the duration of the procedure. However, the occurrence of clot retention is not significantly associated with the duration of haematuria or any of the other clinical factors evaluated. Thus, a high fluid intake is mandatory for 3 weeks after TURP, but men who continue to bleed should be advised to continue with a high-fluid regimen until their urine is clear.

Aspirin, a silent risk factor in urology

Aspirin is a widely used drug for its analgetic, antiinflamatory and antipyretic effects as well as for prophylactic effect in cardiovascular diseases. However, an increased number of operative hemorrhagic complications in patients on daily aspirin have been reported, an adverse effect highly relevant in urology. In this review the normal hemostatic mechanism and the chief pharmacological effect of aspirin on hemostasis is described. The literature is reviewed for hemorrhagic complications to aspirin in urology. Few reports indicate that aspirin increases bleeding and need for transfusion following prostatectomy, but no placebo-controlled clinical trials with large patient groups have been carried out. Following prostate biopsy and extracorporeal shock wave lithotripsy aspirin-induced hemorrhagic complications have been reported. Cessation of aspirin ingestion one week prior to invasive urologic procedures and correction of bleeding complications with desmopressin, platelet concentration or fresh whole blood is described.

Coagulopathies in patients after transurethral resection of the prostate: spinal versus general anesthesia

This prospective, randomized study evaluated the effects of spinal versus general anesthetic technique on perioperative blood loss and the development of postoperative coagulopathies in 50 patients undergoing transurethral resection of the prostate (TURP). Preoperative hematologic measurements included hemoglobin, platelet count, electrolytes, prothrombin time, partial thromboplastin time, fibrinogen, factor V, plasminogen, antithrombin III, and fibrinogen degradation product (FDP) levels. All hematologic blood samples wre repeated postoperatively at 1, 6, and 24 h. Intraoperative blood loss was not significantly different between the spinal and general anesthesia groups. The total blood loss after TURP was significantly correlated (r = 0.76; P < 0.0001) with the prostatic tissue weight. When the tissue weight resected exceeded 35 g, blood loss was in excess of the linear correlation shown with the weight of resected prostatic tissue. Platelet count decreased and prothrombin time increased in the spinal group at all postoperative time intervals compared to preoperative value (P < 0.05). There was no significant difference in measured coagulation variables (fibrinogen, factor V, plasminogen, antithrombin III, and FDP) between the spinal and general anesthesia groups, but there were significant decreases in postoperative fibrinogen and Factor V levels compared to preoperative values in both spinal and general anesthesia groups. Three patients (6%) had increased FDP levels 1 h postoperatively. The prostatic tissue weight and the surgical duration was significantly higher in these patients. We conclude that perioperative blood loss in TURP patients is not affected by the anesthetic technique. However, 6% of TURP patients developed subclinical intravascular coagulopathies which correlated with mass of resected prostate tissue.

Identifiable factors in post-prostatectomy haemorrhage: the role of aspirin

Post-operative haemorrhagic complications following the ingestion of aspirin have been reported after several types of surgery, most notably coronary artery bypass surgery. In this study, aspirin ingestion also appeared to be a significant aetiological factor in post-prostatectomy haemorrhage. This is explained in terms of its inhibitory effect on platelet aggregation. A history of aspirin ingestion should be carefully sought and its haemorrhagic implications considered prior to prostatectomy.

Prophylactic subcutaneous heparin does not increase operative blood loss in transurethral resection of the prostate

A prospective randomised study of subcutaneous heparin compared with no heparin was performed in 60 patients undergoing transurethral resection of the prostate. Operative blood loss in the irrigation fluid was measured using a haemoglobinometer. Blood loss correlated with the amount of prostate resected and the duration of the procedure. Subcutaneous heparin had no significant effect on the measured blood loss in transurethral resection of the prostate and can be used as a safe means of prophylaxis against thrombo-embolic complications.

Blood loss in transurethral prostatectomy: epidural versus general anaesthesia

The peroperative and postoperative blood loss was determined in 36 patients undergoing transurethral prostatectomy (TUR-P) using a photometric method. Seventeen patients were randomly allocated to epidural and 19 patients to general anaesthesia. No significant differences were found between the two groups in the total blood loss peroperatively, the corrected blood loss peroperatively (ml/g/min) or the blood loss postoperatively. The systolic blood pressures were equal in the two groups and no correlation between blood loss and blood pressure was demonstrated. The blood loss per g resected tissue was fairly constant and independent of prostatic weight, but bleeding per minute operating time increased significantly with prostatic size. As the total peroperative blood loss increases with operating time, rapid surgery is a possibility of reducing blood loss in TUR-P. Visual estimation of blood loss during TUR-P of larger glands was unreliable with underestimates of about 100 per cent in one third of the patients, when bleeding exceeded 400 ml. Therefore we recommend an accurate determination of blood loss during resection of larger glands.

Reduction of post-operative bleeding after transurethral resection of the prostate by local instillation of fibrin adhesive (Beriplast)

A method for instilling a two-component fibrin adhesive into the prostatic cavity after transurethral resection of the prostate is described. In a prospective, controlled study, 30 consecutive patients undergoing transurethral prostatectomy (TURP) were randomised either to receive treatment with the local instillation of fibrin adhesive into the prostatic cavity or to a control group that received no special treatment post-operatively. There were no complications either during application of the fibrin adhesive or in the follow-up period. Post-operative blood loss was significantly reduced in the fibrin group (P less than 0.01).