[Assessment of hemorrhage risk of transvesical prostatectomy with bladder neck cerclage].

OBJECTIVE

Evaluation of blood loss and predictive factors of haemorrhagic complications of transvesical prostatectomy.

MATERIAL AND

METHODS

From January 1994 to December 1998, 202 patients with a mean age of 70.5 +/- 7.4 years (range: 46.6-89.3 years) were operated for benign prostatic hyperplasia with a mean prostate weight of 86 +/- 33 g. Transvesical prostatectomy was performed with bladder neck cerclage and suction drainage of the prostatectomy site for 48 hours. 107 patients donated blood preoperatively (mean: 2.8 +/- 0.7 units) to allow possible autotransfusion. Blood losses were evaluated by determining haematocrit during hospitalisation, the quantity of blood collected intraoperatively and the presence of postoperative bleeding possibly requiring surgical revision.

RESULTS

The calculated overall blood loss was 435 +/- 306 ml of RBC, i.e. 1783 ml for an haematocrit of 30%. A high ASA score was significantly related with higher blood loss and preoperative anticoagulant treatment. No predictive factor for intraoperative bleeding (mean: 519 +/- 327 ml) was identified. Absence of the median lobe and a high ASA score were also predictive factors of postoperative bleeding. Age, operating time, prostate weight, recent urinary tract infection, preoperative drainage, preoperative haematocrit, and preoperative blood donation (autotransfusion) did not significantly influence the volume of blood loss.

CONCLUSION

Apart from the ASA score, no predictive factor for the severity of bleeding associated with transvesical prostatectomy was defined in order to identify a group of patients at higher risk of severe bleeding.