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

Abstract

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.

Preoperative Dutasteride Use has no effect on Intraoperative Bleeding during Transvesical Open Simple Prostatectomy for Benign Prostatic Hyperplasia

“…Due to the high risk of perioperative bleeding and transfusion requirement, new operative techniques and medications like 5-ARI have been considered to struggle with perioperative bleeding during open simple prostatectomy [9,10,19]. 5α-reductase converts testosterone into dihydrotestosterone which is more potent.…”

Post-Transurethral Resection of the Prostate Inflation of Pressure-Controlled Endorectal Balloon—Impact on Postoperative Bleeding: A Preliminary Experimental Pilot Study

“…The catheter was inflated with a connected sphygmomanometer pump via its small channel while the sphygmomanometer mercury storage was connected to the catheter large channel to measure the pressure during balloon inflation in the rectum. 16 Rectal balloon was inflated to pressure less than the systolic pressure and above the diastolic of the patient for 15 minutes to avoid pressure necrosis on the rectal wall, after which it was deflated and removed from rectum. The anal sphincter was then inspected for any obvious injuries.…”

“…15 We previously reported our experience in using a new technique to control postoperative blood loss; the rectal balloon (RB) during open simple prostatectomy with convenient promising results in decreasing postoperative blood loss. 16 Therefore, the aim of the present study was to…”