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[Assessment of hemorrhage risk of transvesical prostatectomy with bladder neck cerclage]
E Van Glabeke1, G Corsia, B Barrou
1Service d'Urologie et de Transplantation Rénale, Groupe Hospitalier Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651 Paris. emmanuel.van-glabeke@chi-andre-gregoire.fr
Insights
Transvesical prostatectomy can lead to significant blood loss. A high American Society of Anesthesiologists (ASA) score is a key predictor of bleeding complications, alongside anticoagulant use and median lobe absence.
Area of Science:
- Urology
- Surgical Oncology
- Anesthesiology
Context:
- Transvesical prostatectomy is a surgical procedure for benign prostatic hyperplasia.
- Hemorrhagic complications can occur, necessitating blood loss evaluation.
- Predictive factors for bleeding are crucial for patient risk stratification.
Purpose:
- To evaluate blood loss during transvesical prostatectomy.
- To identify predictive factors for hemorrhagic complications.
- To assess the impact of various patient and surgical parameters on blood loss.
Summary:
- A study of 202 patients undergoing transvesical prostatectomy found overall blood loss averaged 435 +/- 306 ml of RBC.
- A high American Society of Anesthesiologists (ASA) score and preoperative anticoagulant treatment were linked to increased blood loss.
- Absence of the median lobe and a high ASA score predicted postoperative bleeding, while other factors like age and prostate weight did not significantly influence blood loss.
Impact:
- Findings aid in identifying patients at higher risk of bleeding after transvesical prostatectomy.
- Highlights the importance of the ASA score in surgical risk assessment for this procedure.
- Informs preoperative planning and management strategies to mitigate hemorrhagic risks.
Objective:
Evaluation of blood loss and predictive factors of haemorrhagic complications of transvesical prostatectomy.
Material And Methods:
From January 1994 to December 1998, 202 patients with a mean age of 70.5 +/- 7.4 years (range: 46.6-89.3 years) were operated for benign prostatic hyperplasia with a mean prostate weight of 86 +/- 33 g. Transvesical prostatectomy was performed with bladder neck cerclage and suction drainage of the prostatectomy site for 48 hours. 107 patients donated blood preoperatively (mean: 2.8 +/- 0.7 units) to allow possible autotransfusion. Blood losses were evaluated by determining haematocrit during hospitalisation, the quantity of blood collected intraoperatively and the presence of postoperative bleeding possibly requiring surgical revision.
Results:
The calculated overall blood loss was 435 +/- 306 ml of RBC, i.e. 1783 ml for an haematocrit of 30%. A high ASA score was significantly related with higher blood loss and preoperative anticoagulant treatment. No predictive factor for intraoperative bleeding (mean: 519 +/- 327 ml) was identified. Absence of the median lobe and a high ASA score were also predictive factors of postoperative bleeding. Age, operating time, prostate weight, recent urinary tract infection, preoperative drainage, preoperative haematocrit, and preoperative blood donation (autotransfusion) did not significantly influence the volume of blood loss.
Conclusion:
Apart from the ASA score, no predictive factor for the severity of bleeding associated with transvesical prostatectomy was defined in order to identify a group of patients at higher risk of severe bleeding.
