The Clinical Efficacy of Manual Irrigation for the Prevention of Postoperative Bleeding of Transurethral Prostate Resection
La eficacia clínica de la irrigación manual para la prevención del sangrado posoperatorio de la resección transuretral de próstata
Reha Girgin, Necmettin Aydın Mungan
Abstract
Introduction: Postoperative blood loss after prostate surgery is thought to be associated with an increase in urinary fibrinolytic activity. We investigated the effects of the local dilution of fibrinolytic agents with manual irrigation on postoperative bleeding after the transurethral resection of the prostate (TUR-P).
Materials and methods: Between April 2017 and April 2021, 128 patients were prospectively randomised into two equal groups. Monopolar TUR-P was applied to all patients for benign prostatic hyperplasia, but post procedure manual irrigation was used in group 2 only. Haemoglobin levels were evaluated before and after TUR-P. Intra-op and post operative bleeding, amount of saline used for irrigation, duration of catheterisation and length of hospital stay were noted. The patients were followed up 1 month after the TUR-P.
Results: The resected adenoma weight was 12.64 g in group 1 and 13.11 g in group 2. There was no difference between groups 1 and 2 in terms of haemoglobin loss and total blood loss within the first 24 h after TUR-P, which were 0.82 g and 0.95 g (P = 0.443) and 90.45 mL and 67.80 mL (P = 0.102), respectively. There was also no significant difference between the groups in the saline volume used for irrigation (19 vs. 17.3 L), catheter duration and hospital stay (2.6 vs. 2.6 days).
Conclusions: We could not show the positive effects of manual irrigation on bleeding complications after TUR-P, though it is a simple and safe-seeming procedure with no specific operative technique.
Keywords
Resumen
Introducción: Se cree que la pérdida de sangre postoperatoria después de la cirugía de próstata está asociada con un aumento en la actividad fibrinolítica urinaria. Investigamos los efectos de la dilución local de fibrinolíticos con irrigación manual sobre el sangrado postoperatorio tras la resección transuretral de próstata (RTU-P).
Materiales y métodos: entre abril de 2017 y abril de 2021, 128 pacientes fueron aleatorizados prospectivamente en dos grupos iguales. Se aplicó RTU-P monopolar a todos los pacientes por hiperplasia prostática benigna, pero solo en el grupo 2 se usó irrigación manual posterior al procedimiento. Los niveles de hemoglobina se evaluaron antes y después de la RTU-P. Se registraron el sangrado intraoperatorio y posoperatorio, la cantidad de solución salina utilizada para la irrigación, la duración del cateterismo y la duración de la estancia hospitalaria. Los pacientes fueron seguidos 1 mes después de la RTU-P.
Resultados: El peso del adenoma resecado fue de 12,64 g en el grupo 1 y de 13,11 g en el grupo 2. No hubo diferencia entre los grupos 1 y 2 en cuanto a la pérdida de hemoglobina y la pérdida total de sangre dentro de las primeras 24 h después de la RTU-P, que fueron de 0,82. g y 0,95 g (P = 0,443) y 90,45 mL y 67,80 mL (P = 0,102), respectivamente. Tampoco hubo diferencias significativas entre los grupos en el volumen de solución salina utilizada para la irrigación (19 frente a 17,3 l), la duración del catéter y la estancia hospitalaria (2,6 frente a 2,6 días).
Conclusiones: No pudimos mostrar los efectos positivos de la irrigación manual sobre las complicaciones hemorrágicas después de la RTU-P, aunque es un procedimiento simple y aparentemente seguro sin una técnica quirúrgica específica.
Palabras clave
References
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Submitted date:
05/27/2022
Reviewed date:
07/23/2022
Accepted date:
08/06/2022
Publication date:
08/08/2022
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