Department of Urology, University Hospital Antwerp, Edegem, Belgium.
Faculty of Medicine and Health Sciences, Department of Urology and Urological Rehabilitation, University of Antwerp, Antwerp, Belgium.
Prostate. 2023 Dec;83(16):1584-1590. doi: 10.1002/pros.24616. Epub 2023 Aug 21.
Bleeding and bleeding-related complications remain common after bipolar transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. This may possibly lead to prolonged postoperative irrigation, catheterization, and hospital stay. The objective of this trial was to evaluate the effect of high-dose tranexamic acid (TXA) on perioperative blood loss in patients treated with bipolar TURP for prostate sizes between 30 and 80 g.
We conducted a single-center, prospective, double-blind, randomized controlled trial. Eighty patients were screened for inclusion between March 2020 and January 2023. After exclusion, 65 patients were randomized in two comparable groups. The TXA group (31 patients) received a TXA intravenous loading dose of 10 mg/kg over 30 min before induction, followed by a maintenance dose of 5 mg/kg/h over 12 h. The placebo group (34 patients) received an equal dose of saline infusion. We measured age, weight, preoperative prostate size, anticoagulant use, 5-alpha reductase inhibitor use, preoperative urinary tract infection, American Society of Anesthesiologists score, difference in pre- and 24 h postoperative hemoglobin and hematocrit levels, operative time, resected adenoma weight, duration of postoperative irrigation, total amount of postoperative irrigation fluid, indwelling catheter time, duration of hospital stay, blood transfusion rate, and 4-week complication rate.
Baseline characteristics in both groups were comparable. Postoperative hemoglobin decrease in TXA versus placebo group was 1 versus 1.6 mg/dL, respectively (p = 0.04). In addition, the amount of postoperative irrigation fluid (10.7 vs. 18.5 L), irrigation time (24.3 vs. 37.9 h), catheterization time (40.8 vs. 53.7 h), and hospital stay (46.9 vs. 59.2 h) were statistically significant in favor of TXA use. No blood transfusions were carried out. Four-week complication rate was comparable between the two groups.
Perioperative high-dose TXA seems beneficial in reducing hemoglobin loss, postoperative irrigation, catheterization time, and hospital stay in bipolar TURP for prostate sizes between 30 and 80 g, without increased risk of TXA-related thromboembolic events.
在良性前列腺增生的经尿道双极前列腺切除术（TURP）后，出血和与出血相关的并发症仍然很常见。这可能导致术后冲洗、置管和住院时间延长。本试验的目的是评估高剂量氨甲环酸（TXA）对前列腺体积为 30 至 80g 的患者行双极 TURP 治疗时围手术期失血的影响。
我们进行了一项单中心、前瞻性、双盲、随机对照试验。在 2020 年 3 月至 2023 年 1 月期间，共筛选了 80 名患者入组。排除后，65 名患者随机分为两组。TXA 组（31 名患者）在诱导前 30 分钟内静脉给予 TXA 负荷剂量 10mg/kg，然后在 12 小时内给予 5mg/kg/h 的维持剂量。安慰剂组（34 名患者）给予等量生理盐水输注。我们测量了年龄、体重、术前前列腺大小、抗凝药物使用、5-α 还原酶抑制剂使用、术前尿路感染、美国麻醉师协会评分、术前和术后 24 小时血红蛋白和血细胞比容水平的差异、手术时间、切除的腺瘤重量、术后冲洗时间、术后总冲洗液量、留置导尿管时间、住院时间、输血率和 4 周并发症发生率。
两组的基线特征无差异。与安慰剂组相比，TXA 组术后血红蛋白下降 1 与 1.6mg/dL（p=0.04）。此外，TXA 组的术后冲洗液量（10.7 与 18.5L）、冲洗时间（24.3 与 37.9h）、置管时间（40.8 与 53.7h）和住院时间（46.9 与 59.2h）均有统计学意义。没有进行输血。两组 4 周并发症发生率无差异。
在前列腺体积为 30 至 80g 的双极 TURP 中，围手术期使用高剂量 TXA 似乎可以减少血红蛋白丢失、术后冲洗、置管时间和住院时间，且不会增加 TXA 相关血栓栓塞事件的风险。
