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Prevention and management of TURP-related hemorrhage

Nature Reviews Urology volume 8, pages 504–514 (2011)Cite this article

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Abstract

Transurethral resection of the prostate (TURP) is the most common surgical treatment for benign prostatic hyperplasia (BPH) worldwide, but despite its minimally invasive nature, perioperative bleeding remains a common morbidity. Anticoagulant and antiplatelet medications are increasingly common in this patient population and further contribute to the risk of bleeding and extended hospital stay. Preoperative cessation of anticoagulant and antiplatelet drugs is recommended but requires risk assessment of thrombotic complications. Pharmacologic maneuvers to reduce hemorrhage include perioperative administration of 5α-reductase inhibitors. Technical considerations include the use of hemostatic energy sources such as laser and bipolar technologies. Ultimately, no surgical technique is devoid of bleeding risks, and urologists should be aware of how best to prevent and treat TURP-related hemorrhage.

Key Points

  • Traditional factors influencing blood loss during transurethral resection of the prostate (TURP) include prostate size, weight of resected prostate tissue, type of instrumentation, surgeon experience, and catheterization

  • Patient use of anticoagulant or antiplatelet medications can increase the risk of significant TURP-related hemorrhage

  • Cessation of such drugs prior to TURP is recommended only after thorough risk stratification and consultation with the prescribing clinician

  • Treating surgeons must familiarize themselves with the plethora of novel pharmaceutical blood thinners on the market today to avoid error

  • 5α-reductase inhibitors have been shown to decrease prostate microvessel density and reduce intraoperative blood loss in select studies

  • Laser and bipolar technologies offer vaporization, enucleation, and resection alternatives to traditional TURP that involve significantly less blood loss; these procedures can often be performed in the setting of active anticoagulation or antiplatelet therapy

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Figure 1: Mechanism of action of anticoagulation therapies.
Figure 2: Mechanism of action of antiplatelet therapies.

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C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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  1. Department of Surgery, University of Melbourne, Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, Melbourne, 3084, Vic, Australia

    Liam E. Kavanagh, Gregory S. Jack & Nathan Lawrentschuk

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L. E. Kavanagh and N. Lawrentschuk researched data for the article. L. E. Kavanagh wrote the article. L. E. Kavanagh, G. S. Jack and N. Lawrentschuk made substantial contribution to discussion of content, and editing the manuscript before submission.

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Kavanagh, L., Jack, G. & Lawrentschuk, N. Prevention and management of TURP-related hemorrhage. Nat Rev Urol 8, 504–514 (2011). https://doi.org/10.1038/nrurol.2011.106

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