BPH Tranexamic acid decreases blood loss during transurethral resection of the prostate (TUR-P)

Abstract

IntroductionPostoperative blood loss after prostate surgery is thought to be associated with an increase in urinary fibrinolytic activity. Tranexamic acid (TXA) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously. We investigated the effect of TXA on the amount of blood loss during transurethral resection of the prostate (TURP).Materials and methodsForty patients with registry numbers ending in even numbers were allocated to the treatment group; those ending in odd numbers were used as controls and received no treatment. The treatment group received 10 mg/kg TXA by intravenous infusion during the first half hour of the operation, while the control group of patients received no medication. Serum hemoglobin was measured before and after surgery. The volume and hemoglobin concentration of the irrigation fluid, resected prostate weight, and duration of resection were recorded.ResultsThe mean loss of hemoglobin per gram of resected prostate tissue was 1.25 g in the TXA group and 2.84 g in the control group. Total hemoglobin loss in the irrigating fluid and hemoglobin loss per 1 gram of prostate tissue was lower in the group of patients given TXA than in the control group (p = 0.018 and p <0.001).ConclusionReduced bleeding during TURP as a result of TXA treatment may lead to better surgical conditions and, as a consequence, shorter operative times and lower irrigating fluid volumes.

Local Administration of Tranexamic Acid During Prostatectomy Surgery: Effects on Reducing the Amount of Bleeding

“…Benign prostatic hyperplasia (BPH) is a major public health problem affecting men older than 50 years of age (1, 2). In 2008, BPH was the second most frequently diagnosed cancer in men worldwide with an estimated 899,000 new cases (13% of all new cancer cases) (3-7).…”

“…Despite the introduction of laparoscopy (including robotic-assisted approaches), open radical retropubic prostatectomy is still the standard surgical treatment for localized prostate cancer (4, 7-11). The historical gold standard of transurethral resection of prostate (TURP), which is an effective procedure, is still associated with the risk of intraoperative and postoperative bleeding (2, 12-14). …”

“…Factors that influence perioperative and postoperative blood loss include prostate weight, weight of the resected tissue, operating time, preoperative urine culture, preoperative finasteride treatment, use of acetylsalicylic acid, type of anesthesia, patient age, and blood pressure although some of these associations remain controversial (2). …”

“…Recently, a growing body of evidence has indicated that tranexamic acid (TRA) is an effective agent for reducing blood loss in different surgeries (2, 21, 22). In the literature, 16 studies evaluating the use of TRA in cardiac surgery, 6 trials in upper gastrointestinal bleeding, 3 trials in oral surgery, 2 trials in orthopedic surgery, X trials in gynecological surgery, and several other trials evaluating the use of TRA in other indications were included (23).…”

“…TRA, a synthetic derivative of the amino acid lysine that exerts an antifibrinolytic action, is the standard treatment used to reduce the rate of perioperative and intraoperative transfusion by preventing the breakdown of fibrin and stabilizing blood clots (2, 4, 23-26). Treatment with TRA does not seem to adversely affect mortality and morbidity (4, 27).…”