Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

Abstract

Ann R Coll Surg Engl 2010; 92: 555-558 555There are several techniques of transurethral prostatic surgery including the traditional transurethral resection of the prostate (TURP) and newer techniques including holmium laser enucleation of the prostate (HoLEP), Green-light laser photoselective vaporisation of the prostate (PVP) and the Gyrus bipolar system. The number of TURPs is falling 1 and there is no doubt that newer techniques are being accepted as established alternatives. Bleeding is one of the main complications after any modality of endoscopic prostatectomy, including TURP. The incidence of blood loss requiring transfusion is reported to be 0.4-7.1%, 2,3 with rates declining with evolving technology despite an increasingly aged population having prostatic surgery.The experience of surgeons dealing with troublesome bleeding is now, therefore, much less. The conservative, resuscitative and endoscopic measures to deal with bleeding are well established and understood. However, there are occasions when this is not sufficient to stop what may be life-threatening haemorrhage and many surgeons may now be unfamiliar with the surgical technique of packing the prostatic cavity to arrest bleeding when other measures have failed. In this paper, we have reviewed all TURP and PVP procedures over a 3-year period and identified those patients who required surgical intervention postoperatively to arrest continuing haemorrhage and in particular describe open packing of the prostate. Patients and MethodsWe retrospectively reviewed a 3-year period where 437 TURPs and 590 PVPs were performed for lower urinary tract symptoms (LUTS) and for urinary retention in our institution. Of patients who underwent TURP, 19 needed a cystoscopy in the immediate postoperative period for persistent bleeding despite conservative measures such as catheter traction and manual bladder washouts. Two patients who , is uncommon but a significant and life-threatening problem. The knowledge and technical experience to deal with this complication may not be wide-spread among urologists and trainees. We describe our series of TURPs and PVPs and the incidence of postoperative bleeding requiring intervention. PATIENTS AND METHODS We retrospectively reviewed 437 TURPs and 590 PVPs over 3 years in our institution. We describe the conservative, endoscopic and open prostatic packing techniques used for patients who experienced postoperative bleeding. RESULTS Of 437 TURPs, 19 required endoscopic intervention for postoperative bleeding. Of 590 PVPs, two patients were successfully managed endoscopically for delayed haemorrhage at 7 and 13 days post-surgery, respectively. In one TURP and one PVP patient, endoscopic management was insufficient to control postoperative haemorrhage and open exploration and packing of the prostatic cavity was performed. CONCLUSIONS Significant bleeding after endoscopic prostatic surgery is still a potentially life-threatening complication. Prophylactic measures have been employed to reduce peri-operative bleeding but persistent ble...

Unexplained recurrent hematuria and clot retention following transurethral resection of the prostate

“…3 The wide variety of treatments used for the control of severe bleeding from the lower urinary tract reflects the difficulty in controlling the bleeding by any one method alone. 4 Bleeding is the most important complication of TURP.…”

“…2 The incidence of blood loss requiring transfusion is reported to be 0.4-7.1%, with rates declining with evolving technology despite an increasingly aged population having prostatic surgery. 3 Here, we report a case of recurrent hematuria following TURP and required massive blood transfusion.…”

Transurethral Resection of the Prostate and Pre-Operative Anemia, in Men Older Than 60 Years

“…The indications for surgical treatment are as follows: benign prostatic hyperplasia (BPH) and prostate cancer, at an advanced stage, with urine retention, where palliative TURP, as a method of treatment, is applied. From the anesthesiologist's point of view, the specificity of the patients undergoing the transurethral resection of the prostate is that they are the elderly patients, most commonly the ones with multiple comorbidities, cardiovascular, respiratory and cerebrovascular ones, as well as the fact that the above mentioned interventions are most commonly associated with intraoperative and postoperative bleeding (15,16).…”

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

“…14 In patients with uncontrolled post-TURP bleeding, open prostate temporary packing has been advised to control bleeding. 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…”