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Blood loss during transurethral resection of the prostate as measured by the chromium-51 method
Aurélien Descazeaud1, Abdel Rahmene Azzousi, Charles Ballereau
1Department of Urology, CHU Limoges, Limoges, France. aureliendescazeaud@gmail.com
Insights
Transurethral resection of the prostate (TURP) can cause significant blood loss, averaging over 500 mL by postoperative day 3. Preoperative red cell volume and resected tissue weight predict this blood loss, highlighting the utility of the chromium 51 (51Cr) method for accurate measurement.
Area of Science:
- Urology
- Surgical Research
- Hematology
Background:
- Transurethral resection of the prostate (TURP) is a common procedure for benign prostatic hyperplasia (BPH).
- Accurate assessment of blood loss during and after TURP is crucial for patient safety and evaluating surgical techniques.
- Previous methods may underestimate total blood loss, particularly in the postoperative period.
Purpose of the Study:
- To quantify blood loss during TURP using the chromium 51 (51Cr) labeling method.
- To identify predictive factors for blood loss associated with TURP.
- To compare blood loss measurements with previously reported data.
Main Methods:
- A prospective study involving 41 patients undergoing TURP for symptomatic BPH across four French urology centers.
- Red blood cell volume was measured using the 51Cr method preoperatively and on postoperative day 3.
- Blood loss was calculated by the change in red cell volume multiplied by preoperative hematocrit.
Main Results:
- The mean estimated blood loss from TURP up to postoperative day 3 was 507 mL.
- Significant predictors of blood loss included preoperative red cell volume and the weight of resected prostatic tissue.
- No significant difference in blood loss was observed between bipolar and monopolar TURP techniques.
Conclusions:
- The 51Cr method provides a comprehensive assessment of blood loss during and after TURP, including the postoperative phase.
- Average blood loss exceeds 500 mL, a higher figure than previously reported by other methods.
- The 51Cr method is recommended for evaluating new BPH management techniques due to its accuracy in measuring blood loss.
Purpose:
To evaluate blood loss during transurethral resection of the prostate (TURP), and its predictive factors, using the chromium 51 (51Cr) labeling method.
Patients And Methods:
From January to June 2008, 41 patients who underwent TURP for symptomatic benign prostatic hyperplasia (BPH) at four French urology centers were included in the analysis. Red cells volume was measured by the 51Cr method 1 day before TURP, and on postoperative day 3. Overall blood loss was estimated by multiplication of red cells volume loss and preoperative venous hematocrit value.
Results:
Mean preoperative red cells volume was 1997 mL. Mean loss of red cells volume was 209 ml, which corresponds to an estimated blood loss of 507 mL. Mean delta of hematocrit and hemoglobin were 1.4% and 0.71 g/dL, respectively. In univariate analysis, prostate volume, weight of resected tissue, preoperative red cells volume, and resection time were significantly and directly associated with loss of red cells volume (P = 0.038, P = 0.004, P = 0.002, and P = 0.039, respectively). Bipolar and monopolar TURP did not lead to significant difference of red cells loss. In multivariate analysis, both preoperative red cells volume and weight of resected tissue were independent predictors of red cells loss (P = 0.017 and P = 0.048 respectively).
Conclusion:
We present the first study to measure blood loss secondary to TURP using the 51Cr method. This technique allowed evaluating blood loss not only during the surgical procedure but also during the postoperative period. We learned from this study that, on average, blood loss from the procedure until postoperative day 3 was more than 500 mL, which is larger than previously reported amounts as measured by other methods. Because significant blood loss might occur during the postoperative period, the 51Cr method should be used to measure blood loss when evaluating new emerging techniques to manage BPH.
