The Utility of Tranexamic Acid in Endoscopic Surgeries for Benign Prostatic Hyperplasia

Tranexamic acid (TXA) is an anti-fibrinolytic agent that prevents degradation of fibrin by blocking the ability of plasminogen to bind to fibrin and the proteolytic activity of plasmin. TXA has been proven to be useful in reducing bleeding complications in multiple types of surgery. In this article, we will review the current usage of TXA in endoscopic surgeries for benign prostatic hyperplasia (BPH).

The use of TXA for endoscopic BPH surgeries has mainly been studied for transurethral resection of the prostate (TURP). In the clinical trials assessing the use of TXA and TURP, TXA demonstrated reduced intraoperative bleeding independent of administration route. However, this did not consistently translate to reduced hospitalization or catheterization times. Evidence for the use of TXA and holmium laser enucleation of the prostate (HoLEP) has begun to emerge, and to date limited benefit has been demonstrated. This result is likely due to the excellent innate hemostatic control associated with the procedure. However, further studies are required to validate these findings. With recent innovation in new types of endoscopic BPH surgeries, the benefit of TXA during other types of BPH procedures also require more study. Within the context of endoscopic surgeries for BPH, TXA appears to have the most benefit when performing TURP. More evidence is required to conclude on the benefit in other types of BPH surgery including HoLEP.