Bleeding Following Retropubic Prostatectomy: Simple Digital Rectal Pressure Could Be Lifesaving

Kirollos, Magdi M.

doi:10.1016/s0022-5347(01)62928-8

Cited by 8 publications

(7 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Bleeding following open prostatectomy is still the most common early surgical complication [10]. Hedican and Walsh [11] found that mechanical factors, such as nonligated or poorly ligated vessels, are an uncommon cause of bleeding postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Estimated Blood Loss Underestimates Calculated Blood Loss during Radical Retropubic Prostatectomy

et al. 2004

View full text Add to dashboard Cite

Objective: To compare the calculated blood loss for radical retropubic prostatectomy (RRP) with the anesthesiologist’s and operating surgeon’s estimates of operative blood loss. Methods: A retrospective review of 52 consecutive patients undergoing RRP between January 1999 and February 2000 was performed. Patient charts were reviewed for preoperative hemoglobin (Hgb_i), preoperative hematocrit (Hct_i), body weight (Wt), anesthesiologist’s and surgeon’s estimated blood loss (EBL_A and EBL_S), and postoperative day one morning hemoglobin (Hgb_f) and hematocrit (Hct_f). For each patient, the actual blood loss (ABL), i.e., the amount of blood that left the patient’s body, was calculated as the average ABL_n resulting from two computations of the following formula: ABL_n = (EBV × (H_i – H_f)) / ((H_i + H_f)/2) + (500 × T_u) where: (1) estimated blood volume (EBV) is assumed to be 70 cm³/kg; (2) H_i and H_f represent Hgb_iand Hgb_f for one computation and Hct_i and Hct_f for the second computation, and (3) T_u is the sum of autologous whole blood (AWB), packed red blood cells (PRBC), and cell saver (CS) units transfused. For each patient, ABL was compared with EBL_A and EBL_S. Descriptive statistics of the pooled data were calculated. Results: The mean (± SD) age was 60 ± 7.1 years. The mean ABL was 2,774 ± 1,014 cm³. Patients received an average of 1.96 U CS, 0.14 U PRBC, and 0.42 U AWB. Five patients (9.6%) were exposed to homologous blood. The average ABL_net (i.e. ABL reduced by the amount of CS returned) was 1,794 ± 806 cm³. EBL_A and EBL_S were 1,337 ± 676 and 1,300 ± 658 cm³, respectively. Conclusion: During radical retropubic prostatectomy, anesthesiologists and urologists both appear to underestimate blood loss as determined by standard calculation.

show abstract

Section: Discussionmentioning

confidence: 99%

Estimated Blood Loss Underestimates Calculated Blood Loss during Radical Retropubic Prostatectomy

et al. 2004

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…Although improvements in the technique for RRP have improved outcomes dramatically, blood loss during RRP is still a major concern because of the prostate's rich venous supply. 1,2 The impact of significant intraoperative blood loss on the patient's outcome is multifactorial. Patients with lower postoperative hemoglobin after orthopedic and colorectal surgeries have been associated with prolonged hospitalization, 3,4 and in RRP lower blood loss has been associated with better short-term and long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

Effect of positive end‐expiratory pressure on blood loss during retropubic and robot‐assisted laparoscopic radical prostatectomy

et al. 2016

View full text Add to dashboard Cite

Objectives: To study the effect of end-expiratory pressure used during anesthesia on blood loss during radical prostatectomy. Methods: We evaluated 247 patients who underwent either radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy at a single institution from 2008 to 2013 by one of four surgeons. Patient characteristics were compared using ttests, rank sum or v 2 -tests as appropriate. The association between positive endexpiratory pressure and estimated blood loss was tested using linear regression. Results: Patients were classified into high (≥4 cmH 2 O) and low (≤1 cmH 2 O) positiveend expiratory pressure groups. Estimated blood loss in radical retropubic prostatectomy was higher in the high positive end-expiratory pressure group (1000 mL vs 800 mL, P = 0.042). Estimated blood loss in robot-assisted laparoscopic prostatectomy was lower in the high positive end-expiratory pressure group (150 mL vs 250 mL, P = 0.015). After adjusting for other factors known to influence blood loss, a 5-cmH 2 O increase in positive end-expiratory pressure was associated with a 34.9% increase in estimated blood loss (P = 0.030) for radical retropubic prostatectomy, and a 33.0% decrease for robot-assisted laparoscopic prostatectomy (P = 0.038). Conclusions: In radical retropubic prostatectomy, high positive end-expiratory pressure was associated with higher estimated blood loss, and the benefits of positive end-expiratory pressure should be weighed against the risk of increased estimated blood loss. In robot-assisted laparoscopic prostatectomy, high positive end-expiratory pressure was associated with lower estimated blood loss, and might have more than just pulmonary benefits.

show abstract

“…We combined the idea of a pressure-controlled balloon used in the Sengstaken tube, and the pressure applied on the prostate blood supply from the rectum, described by Kirollos [10] and modified by Osman et al [11] . We then developed our new technique (RB), with a measured pressure in the rectum to avoid pressure necrosis on the rectal wall, to facilitate haemostasis.…”

Section: Discussionmentioning

confidence: 99%

“…Other techniques are capsular plication either longitudinal or transverse, packing the prostatic fossa with gauze or by an inflated catheter balloon, early vascular control before cystotomy, and transurethral endoscopic coagulation by a second surgical team [8,9] . Kirollos [10] reported that life-threatening bleeding after prostatectomy (the patient received 12 units of blood) was controlled only by anterior digital rectal pressure for 10 min. Thereafter, Osman et al [11] used a gauze pack inserted into the patient’s rectum opposing the prostate, after TVP.…”

Section: Introductionmentioning

confidence: 99%

Open prostatectomy with a rectal balloon: A new technique to control postoperative blood loss

Mohyelden

Abdel-Kader

2015

Arab Journal of Urology

View full text Add to dashboard Cite

ObjectivesTo evaluate a new technique, the rectal balloon (RB), to control blood loss after transvesical prostatectomy (TVP).Patients and methodsOver 2 years 100 patients were prospectively randomised into two equal groups. All patients underwent TVP for their benign prostatic hyperplasia but a RB (a balloon fixed to a three-way Foley catheter tip by a plaster strip, making it airtight) was used in group 2. The RB was placed in the rectum opposing the prostate and inflated (pressure controlled) for 15 min. Haemoglobin levels were assessed before and after TVP. Blood transfusion, the amount of saline used for irrigation, duration of catheterisation, hospital stay, and rectal complaints were recorded. Patients were followed up at 1 and 3 months after TVP.ResultsThe enucleated adenoma weight was 102 g in group 1 and 106 g in group 2. There was a significant difference between groups 1 and 2 in haemoglobin loss within the first 24 h after TVP, and in total loss, of 0.9 g and 0.2 g (P = 0.008), and 1.9 g and 1 g (P = 0.001), respectively. There was also a significant difference between the groups in the saline volume used for irrigation (11.4 vs. 2.5 L), catheter duration (5.7 vs. 4.3 days), and hospital stay (6.2 vs. 5.1 days), favouring group 2. Blood transfusions were needed in four patients in group 1 and one in group 2. There were no rectal complaints.ConclusionThe use of an inflated RB after TVP is a simple and safe procedure with no specific operative technique, that reduces postoperative blood loss, the incidence of blood transfusion, the volume of saline for irrigation, and shortens the catheterisation period and hospital stay, with no rectal complications.

show abstract

Bleeding Following Retropubic Prostatectomy: Simple Digital Rectal Pressure Could Be Lifesaving

Abstract: Simple digital rectal pressure is a safe, effective and logical method of controlling venous bleeding from the dorsal venous or other plexus between the rectum and symphysis pubis.

Cited by 8 publications

References 5 publications

Estimated Blood Loss Underestimates Calculated Blood Loss during Radical Retropubic Prostatectomy

Estimated Blood Loss Underestimates Calculated Blood Loss during Radical Retropubic Prostatectomy

Effect of positive end‐expiratory pressure on blood loss during retropubic and robot‐assisted laparoscopic radical prostatectomy

Open prostatectomy with a rectal balloon: A new technique to control postoperative blood loss

Contact Info

Product

Resources

About