1 / 32

Prevention and Management of TURP-Related Hemorrhage

Dr. Abdullah Ahmad Ghazi (R5) KSMC 8 May 2012. Prevention and Management of TURP-Related Hemorrhage. TURP  gold standard in BPH Using of A-Cog & A-Plt is increasing. 4% on A-Cog 37% on A-plt. Introduction. The most common perioperative complication in TURP is hemorrhage.

anne
Download Presentation

Prevention and Management of TURP-Related Hemorrhage

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dr. Abdullah Ahmad Ghazi (R5) KSMC 8 May 2012 Prevention and Management of TURP-Related Hemorrhage

  2. TURP  gold standard in BPH • Using of A-Cog & A-Plt is increasing. • 4% on A-Cog • 37% on A-plt Introduction

  3. The most common perioperative complication in TURP is hemorrhage. • Blood transfusion 20% (Uchida 1999) • 2.9% (Reich 2008) Introduction

  4. Prolonged operative time. Capsular perforation. Fluid absorption Bleeding Can Lead To

  5. Large prostate. Concurrent UTI. Indwelling urinary catheters. Risk Factors

  6. Warfarin  reversible A-plt  non reversible Warfarin in AF ? Risk Warfarin in cardiac stent ? risk Note

  7. High risk: • Hx intracardiac thrombus. • TIA. • Stroke. • Recent, recurrent UTI • PE • Prosthetic valve • Low risk: • AF • DVT Risk Classification

  8. Warfarine: • Vit-k dependent. • Clotting factor (II, VII, IX, X) • T1/2: 25-60 hr. • Duration of action 2-5 days Anticoagulant

  9. Katholi et al • TURP done for 12 pt on warfarin (INR 2.3) • 33% need transfusion. • Mulcahy et al • Recommend start warfarin once hematuria resolved = 48hrs. • High risk should received LMWH w/o risk of bleeding Anticoagulant

  10. Most guidelines recommend: • Stop warfarin 5 days before surgery. • LMWH 4days preop to 1 day preop • INR must be <1.5 day of surgery Anticoagulant

  11. Heparin: • Antithrombin, inactivate II, IX, X, XI, XII. • T1/2 1-6hr • Using of Heparine pre-post TURP not increase risk of bleeding Anticoagulant

  12. LMWH: • Inhibit factor X. • T1/2 8-10h • ½ dose if cre clea < 30ml/min • High risk should received LMWH preop and resume it within 48hrs. • No increase risk of bleeding. • Increase hospitalization and catheterization Anticoagulant

  13. Aspirin & NSAID: • Inhibit TXA2 • Stop ASA  BT return tnormal in 48hrs. Sonksen 1999 • Common prectice is to stop ASA 7-10D. Enver 2006. “no evidence, & harm to high risk”. Antiplatelet Medication

  14. 20% of pt for TURP have IHD or CVA. Gyomber 2006. • Nielsen et al 2000: • Randomize trial. • TURP (continue vs holding ASA for 10d) • No significant intra-op bleeding loss. • Postoperative higher blood loss (284ml vs 44ml) • No difference in transfusion or cauterization. Antiplatelet Medication

  15. Ehrlich et al 2007: • No increase of bleeding if ASA resume at stopping irrigation vs 21 days. Antiplatelet Medication

  16. The American College of Chest Physicians: Suggest to continued ASA perioperatively in high-risk pt undergo noncardiac surgery, but stop ASA in low risk and resume it within 24hrs post-op. Antiplatelet Medication

  17. NSAID can be withheld a week before surgery. Antiplatelet Medication

  18. Thienopyridines: • ADP receptor blocker. • Platelet function return after 7 days. Antiplatelet Medication

  19. Incidence of stent thrombosis: • 31% of clopidogrel stopped • 0% if dual anti-plt Schouten 2007 Antiplatelet Medication

  20. The American College of Chest Physicians: • Clopidogrel should toped 7 days pre-op. • Prostatic surgery should be postpone 12w after coronary stent. Antiplatelet Medication

  21. Treatment of TURP related bleeding

  22. Finastride stop 98% of idiopathic prostate bleeding. Donohue 2004 • Bleeding is • 7.6ml/gm (Fins) • 14mlml/gm (control). Ozdal 2005 • Dutasteride study  no difference. • Increase the cost Treatment of TURP related bleeding

  23. Antifibrinolytics “Tranexamic acid” • Dose 1gm Q6hr (IV, intravesical). • It decrease the amount of bleeding & irrigated fluid used. • Can be used in high risk pt for bleeding. Treatment of TURP related bleeding

  24. Epinephrine: • Need more studies. Treatment of TURP related bleeding

  25. Loop & Electrode Technology: • Thin-wire loops • Solid electrodes • Thick hybrid loops Minimizing TURP-related Blood Loss

  26. TURP vs TUVP bleeding ( 150ml vs 52.5ml) P<0.0001. Gupta 2006 Minimizing TURP-related Blood Loss

  27. Bipolar Electrical Generators: • Use low voltages. • Less thermal deep tissue injury. • Improve hemostasis (decrease bleeding, no diff in transfusion) Minimizing TURP-related Blood Loss

  28. Laser Technology: • Ahyai et al 2010: • HoLEP is effective as TURP. • Decrease risk of bleeding. • It is safe in full anticoagulant. Minimizing TURP-related Blood Loss

  29. Minimizing TURP-related Blood Loss

  30. Ruszat et al 2007: • Photovaporization of the prostate is equivalent to TURP in small/medium prostate. Minimizing TURP-related Blood Loss

More Related