Perioperative platelet inhibition in transurethral interventions: TURP/TURB

To determine whether transurethral surgery under platelet inhibition is a feasible procedure. Before transurethral resection of prostate (TURP) or bladder tumours (TURB), the administration of platelet-inhibiting medication is often interrupted due to possible bleeding complications. We studied the performance of TURP and TURB under the current recommendations of the American College of Chest Physicians (ACCP) on perioperative platelet inhibition.

Patients assigned for transurethral intervention were preoperatively divided into the following risk groups: low, medium and high cardio- or cerebrovascular risk. In patients with a low-risk profile, acetylsalicylic acid (ASA) was discontinued. Patients of the medium risk group continued taking 100 mg of ASA. Patients of the high-risk group receiving dual platelet inhibition (ASA + clopidogrel) were not treated operatively. In total 346 patients from the low and medium risk groups underwent transurethral intervention.

Forty-two out of 198 TURP were performed under 100 mg of ASA. Without ASA, a significantly shorter length of stay and earlier removal of the transurethral catheter was documented. In the parameters postoperative haemorrhage and operative revision, no significant differences were observed. Thirty-two out of 148 TURB were performed under 100 mg of ASA. Regarding the length of stay, time until catheter removal, postoperative haemorrhage and operative revision, no significant differences were found under ASA. Only significantly longer continuous irrigation was documented under ASA.

In the case of a verified indication for use of platelet inhibitors, it is possible to avoid discontinuation and the consequent increased risk of thromboembolic incidents in transurethral surgery is admissible.