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Transurethral Resection of the Prostate (TURP)

 

Blood Transfusion Following Transurethral Resection of the Prostate

Benign prostatic enlargement is a common problem among men over 55 years old. The prostate gland is located around the outlet of the bladder, and thus its enlargement can obstruct the flow of urine, giving rise to symptoms like slow urine flow, sense of incomplete emptying, urgency and frequency.

The gold standard surgical treatment for benign prostatic enlargement is a Transurethral Resection of the Prostate (TURP). TURP is a minimally invasive procedure which removes the obstructing part of the prostate and restores the width of the urinary channel for good urine flow. In the past, bleeding during TURP was a common problem, which resulted in a frequent need for blood transfusion during operation. The significant bleeding also limited the surgeons’ view to do a thorough job in resecting the obstructing prostate.

Many technical advances in the last few decades have made TURP a safe procedure that is suitable for the majority of patients suffering from prostatic enlargement. An example is the bipolar resection technology, which allows much better bleeding control during TURP, minimising blood loss and safely increasing the operative time limit for the surgeon to do a thorough resection.

The Department of Urology in Khoo Teck Puat Hospital has utilised this bipolar resection technology as a routine practice for our patients undergoing TURP, as we believe that we should only offer the safest options to our patients. To date, we have performed TURP for hundreds of patients with excellent clinical outcome. Severe bleeding incidences are highly unlikely and the requirement for blood transfusion has been kept to a minimum. From January 2016 to June 2018, the mean rate was 0.7% (n=3), which is lower than international rate of 6.2% (International Brazilian Journal, 2016).

References:

1. Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N'dow J, Nordling J, de la Rosette JJ; European Association of Urology. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013 Jul;64(1):118-40

2. Shum CF, Mukherjee A, Teo CP. Catheter-free discharge on first postoperative day after bipolar transurethral resection of prostate: clinical outcomes of 100 cases. Int J Urol 2014 Mar;21(3):313-8

3. International Brazilian Journal of Urology, 2016 Mar-Apr; 42(2): 302-311. Analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture following transurethral resection of prostate (doi: 10.1590/S1677-5538.IBJU.2014.0500)