EFFICACY AND SAFETY OF POSTOPERATIVE INTRAVESICAL ADMINISTRATION OF TRANEXAMIC ACID AFTER TRANSURETHRAL RESECTION OF THE PROSTATE

Year 2023, Volume: 86 Issue: 4, 302 - 306, 01.12.2023

Yasin Yitgin , Ayhan Karaköse

https://doi.org/10.26650/IUITFD.1326560

Abstract

Objective: To evaluate the safety and efficacy of postoperative intravesical administration of tranexamic acid after transurethral resection of the prostate.
Material and Method: The data of 112 patients who underwent surgery for lower urinary tract symptoms associated with benign prostatic obstruction (BPO) were retrospectively analysed. We formed two groups. Group 1 consisted of 57 patients who received tranexamic acid by irrigation fluid after the operation; group 2 consisted of 55 patients who did not receive tranexamic acid. Demographic data of patients and prostate characters, as well as operative and postoperative data were analysed. Postoperative bleeding in all patients was evaluated using the haemoglobin levels at the preoperative, and at 0- and 24-h postoperative were evaluated and noted.
Result: The mean ages of the patients were 66.9±7.2 (55-81) years in the intervention group, and those in the control group were 68.6±7.6 (55-80) years. There were no significant differences between the groups for demographic data, prostate volume and IPSS. The reduction in Hb at 24 hours postoperatively was greater in the control group compared to the TXA group. Statistically significant differences were found between the two groups in terms of postoperative haemoglobin decrease, bladder irrigation time and total amount of irrigation fluid. There were no statistically significant differences between each group regarding the operation, weight of resected adenoma, hospitalization time and catheter removal time.
Conclusion: A postoperative follow-up process with less bleeding and complications is possible with tranexamic acid added to the intravesical irrigation fluid used after TURP surgery.

Keywords

Tranexamic acid, transurethral resection of the prostate, irrigation fluid, postoperative bleeding

TRANSÜRETRAL PROSTAT REZEKSİYONU SONRASI POSTOPERATİF İNTRAVEZİKAL TRANEKSAMİK ASİT UYGULAMASININ ETKİNLİĞİ VE GÜVENLİĞİ

Abstract

Amaç: Benign prostat hiperplazili hastalarda transüretral prostat rezeksiyonu sonrası postoperatif intravezikal traneksamik asit uygulamasının güvenlik ve etkinliğini değerlendirmek.
Gereç ve Yöntem: Benign prostat hiperplazisine bağlı alt üriner sistem semptomları nedeniyle ameliyat edilen 112 hastanın verileri geriye dönük olarak incelendi. İki grup oluşturuldu. Grup 1'de operasyon sonrası irrigasyon sıvısı ile traneksamik asit uygulanan 57 hasta, grup 2'de traneksamik asit uygulanmayan 55 hasta mevcuttu. Hastaların demografik verileri, prostat özellikleri, operatif ve postoperatif verileri analiz edildi. Tüm hastalarda ameliyat sonrası takiplerindeki kanama miktarları; preoperatif ve postoperatif 0. ve 24. saatlerde hemoglobin düzeyleri kullanılarak değerlendirildi ve not edildi.
Bulgular: Traneksamik asit grubundaki hastaların yaş ortalaması 66,9±7,2 (55-81) yıl, kontrol grubundakiler ise 68,6±7,6 (55-80) yıl idi. Demografik veriler, prostat hacmi ve IPSS açısından gruplar arasında anlamlı fark yoktu. Postoperatif 24 saatte hemoglobindeki azalma, traneksamik asit grubuna kıyasla kontrol grubunda daha fazlaydı. Postoperatif hemoglobin düşüşü, mesane irrigasyon süresi ve toplam irrigasyon sıvısı miktarı açısından iki grup arasında istatistiksel olarak anlamlı fark bulundu. Ameliyat süresi, rezeke edilen adenomun ağırlığı, hastanede kalış süresi ve kateter çıkarma süresi açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu.
Sonuç: TURP ameliyatı sonrası kullanılan intravezikal irrigasyon sıvısına eklenen traneksamik asit ile ameliyat sonrası daha az kanama ve komplikasyon ile takip süreci mümkündür.

Keywords

Traneksamik asit, transuretral prostat rezeksiyonu, irrigasyon sıvısı, postoperatif kanama

Supporting Institution

Ek Bilgiler Destekleyen Kurum

References

• 1. Coskuner ER, Ozkan TA, Koprulu S, Dillioglugil O, Cevik I. The role of the bipolar plasmakinetic TURP over 100 g prostate in the elderly patients. Int Urol Nephrol 2014;46(11):2071-7. [CrossRef] google scholar
• 2. Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Transurethral prostatectomy immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3, 885 patients. J Urol 2002;167(1):999-1003. [CrossRef] google scholar
• 3. Sun F, Sun X, Shi Q, Zhai Y. Transurethral procedures in the treatment of benign prostatic hyperplasia: A systematic review and meta-analysis of effectiveness and complications. Medicine (Baltimore) 2018;97(51):e13360. [CrossRef] google scholar
• 4. Yang TY, Chen M, Lin WR, Li CY, Tsai WK, Chiu AW, et al. Preoperative treatment with 5a-reductase inhibitors and the risk of hemorrhagic events in patients undergoing transurethral resection of the prostate - A population-based cohort study. Clinics (Sao Paulo) 2018;73:e264. [CrossRef] google scholar
• 5. Mina SH, Garcia-Perdomo HA. Effectiveness of tranexamic acid for decreasing bleeding in prostate surgery: a systematic review and meta-analysis. Cent European J Urol 2018;71(1):72-7. [CrossRef] google scholar
• 6. Kumsar S, Dirim A, Toksöz S, Sağlam HS, Adsan O. Tranexamic acid decreases blood loss during transurethral resection of the prostate (TUR -P). Cent European J Urol 2011;64(3):156-8. [CrossRef] google scholar
• 7. Jendoubi A, Malouch A, Bouzouita A, Riahi Y, Necib H, Ghedira S, et al. Safety and efficacy of intravenous tranexamic acid in endoscopic transurethral resections in urology: Prospective randomized trial. Prog Urol 2017;27(16):1036-42. [CrossRef] google scholar
• 8. Nielsen JD, Gram J, Holm-Nielsen A, Fabrin K, Jespersen J. Post-operative blood loss after transurethral prostatectomy is dependent on in situ fibrinolysis. Br J Urol 1997;80(6):889-93. [CrossRef] google scholar
• 9. Karakose A, Aydogdu O, Atesci YZ. BiVap saline vaporization of the prostate in men with benign prostatic hyperplasia: our clinical experience. Urology 2014;83(3):570-5. [CrossRef] google scholar
• 10. Martin K, Breuer T, Gertler R, Hapfelmeier A, Schreiber C, Lange R, et al. Tranexamic acid versus e-aminocaproic acid: Efficacy and safety in paediatric cardiac surgery. Eur J Cardiothorac Surg 2011;39(6):892-7. [CrossRef] google scholar
• 11. Karkhanei B, Musavi-Bahar SH, Bayat M, Kaseb K, Rezaee H, Moradi A, et al. Safety and efficacy of intraoperative administration of intravenous tranexamic acid in transurethral resection of prostate: a double-blind, randomised, placebo-controlled trial. J Clin Urol 2020;13(2):125-31. [CrossRef] google scholar
• 12. Vezhaventhan G, Soundarya G, Saravanan K, Govindarajan P. Is tranexamic acid effective in reducing TURP related blood loss? A prospective study. Int J Curr Res Life Sci 2018;7(6):2226-28. google scholar
• 13. Samir M, Saafan AM, Afifi RM, Tawfick A. Can high-dose tranexamic acid have a role during transurethral resection of the prostate in large prostates? A randomised controlled trial. Arab J Urol 2021;20(1):24-9. [CrossRef] google scholar
• 14. Longo MA, Cavalheiro BT, de Oliveira Filho GR. Systematic review and meta-analyses of tranexamic acid use for bleeding reduction in prostate surgery. J Clin Anesth 2018;48:32-8. [CrossRef] google scholar
• 15. Meng QQ, Pan N, Xiong JY, Liu N. Tranexamic acid is beneficial for reducing perioperative blood loss in transurethral resection of the prostate. Exp Ther Med 2019;17(1):943-7. [CrossRef] google scholar
• 16. Gupta A, Priyadarshi S, Vyas N, Sharma G. Efficacy of tranexamic acid in decreasing primary hemorrhage in transurethral resection of the prostate: A novel combination of intravenous and topical approach. Urol Ann 2021;13(3):238-42. [CrossRef] google scholar
• 17. Murkin JM, Falter F, Granton J, Young B, Burt C, Chu M. High-dose tranexamic acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg 2010;110(2):350-3. [CrossRef] google scholar
• 18. Henry DA, Carless PA, Moxey AJ, O’Connell D, Stokes BJ, Fergusson DA, et al. Antifibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2011;(1):CD001886. [CrossRef] google scholar
• 19. Sharma V, Katznelson R, Jerath A, Garrido-Olivares L, Carroll J, Rao V, et al. The association between tranexamic acid and convulsive seizures after cardiac surgery: a multivariate analysis in 11 529 patients. Anaesthesia 2014;69(2):124-30. [CrossRef] google scholar