[Coagulation disorders after endoscopic resection of the prostate]

Area of Science:

• Urology
• Hematology
• Surgical Oncology

Context:

• Endoscopic prostate resection, including transurethral resection of the prostate (TURP), is a common surgical procedure.
• Coagulation disorders, such as hypercoagulability and hemorrhage, present significant challenges during and after TURP.
• The incidence of deep vein thrombosis (DVT) post-TURP without heparin prophylaxis is approximately 10%, with increased risk in cancer patients.

Purpose:

• To review the diagnostic approaches and management strategies for coagulation disorders encountered during endoscopic prostate resection.
• To highlight the specific risks of deep vein thrombosis and hemorrhage associated with TURP.
• To outline treatment options for various coagulopathies, including dilution coagulopathy and fibrinolysis.

Summary:

• Diagnostic tools for DVT include Doppler ultrasonography and phlebography; pulmonary angiography is used for suspected pulmonary emboli.
• Hemorrhage is often linked to dilution coagulopathy, influenced by factors like blood pressure and fluid absorption.
• Treatment focuses on clinically significant disorders, utilizing fresh plasma for dilution coagulopathies/DIC and aprotinin for fibrinolysis.

Impact:

• Improved understanding of TURP-related coagulation risks can lead to better patient stratification and preventative strategies.
• Timely diagnosis and appropriate management of coagulopathies can reduce surgical complications and improve patient outcomes.
• This review provides a clinical framework for managing complex hemostatic challenges in urological surgery.