Blood loss in transurethral prostatectomy: Epidural versus general anaesthesia

Abstract

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.

Risk Factors in Prostatectomy Bleeding: Preoperative Urinary Infection is the only Reversible Factor

“…This is in agreement with some previous studies [4, 12], but at variance with many others [6, 7, 13, 14, 15]. The reason for this inconsistency is not clear, but it may be that regional anaesthesia causes less blood loss only if it causes hypotension.…”

“…These three are obviously interrelated. The weight of the resected prostate tissue is the single most consistently incriminated factor among all identifiable factors of TURP bleeding [3, 4, 5, 6, 7, 9, 11, 12]. In our study, it was also the factor with the strongest positive correlation with total blood loss, although in multiple regression analysis it ranked second to operating time.…”

“…Many previous studies have addressed the question of factors influencing TURP bleeding [3, 4, 5, 6, 7, 8, 9, 10]. Each study usually addressed a few factors (usually 2–5), and different studies used different methods of blood estimation, making comparison of studies or extrapolation of results difficult.…”

“…The reason for this inconsistency is not clear, but it may be that regional anaesthesia causes less blood loss only if it causes hypotension. However, regional anaesthesia has some claims to a beneficial effect on TURP bleeding despite the absence of any drop in blood pressure [4, 7]. …”

“…On the other hand, many of the so far studied factors are still controversial, being associated with bleeding in some studies and denied such association in others. Such factors include age of patient and mean blood pressure [8], operating time [5, 6], type of anaesthesia [4, 6], gland histology [6, 9]and many others. In this prospective study, we aim at finding out whether any of a set of predefined clinical and laboratory parameters correlate with blood loss caused by TURP.…”