Risk Factors of Emergency Room Visits for Bleeding Complications Following Transurethral Procedures in the Treatment of Benign Prostatic Hyperplasia: A Retrospective Cohort Study

Abstract

Purpose Transurethral procedures, including transurethral resection of the prostate (TURP) and laser prostatectomy, are often linked to emergency room (ER) visits for postoperative bleeding. Although some studies have been conducted, the risk factors associated with these ER visits are not completely understood. This retrospective cohort study identified potential risk factors associated with ER visits for postoperative bleeding. Patients and Methods Preoperative assessment data and operational and postoperational parameters recorded at Chang Gung Memorial Hospital, Taiwan between December 2015 and January 2017 for patients who underwent elective transurethral procedures were analyzed to identify potential risk factors. The primary endpoint was ER visits for gross hematuria within three months following operation, and the secondary endpoint was ER visits for blood clot-induced urinary retention (clot retention) within three months following operation. Results A total of 665 patients who underwent elective transurethral procedures were enrolled. The transurethral procedures included monopolar transurethral resection of the prostate (M-TURP), bipolar TURP (B-TURP), greenlight photoselective vaporization of the prostate (PVP), thulium laser enucleation of the prostate (ThuLEP) and thulium laser transurethral vaporesection of the prostate (ThuVARP). Regarding ER visits for clot retention within three months, multivariable logistic regression revealed significantly lower rates of clot retention in patients who received B-TURP than in those who underwent ThuVARP (AOR, 0.18; 95% confidence interval [CI], 0.04–0.82, p = 0.027). Moreover, significantly higher clot retention was observed in patients who underwent two or more rounds of manual irrigation (AOR, 9.51; 95% CI, 1.66–54.43, p = 0.011). Conclusion Multiple manual irrigations shortly after operation can be considered a novel predictor of postoperative clot retention-related ER visits. Among the transurethral procedures, ThuVARP was associated with a higher risk of clot retention-related ER visits than was B-TURP.

Observation of complications assessed by Clavien-Dindo classification in different endoscopic procedures of benign prostatic hyperplasia: An observational study

“…Furthermore, secondary hemorrhage can result in blood clot formation and deciduous scab aggregation, followingly leading to urinary tract obstruction and clot retention. [ 19 , 20 ]…”

“…Furthermore, secondary hemorrhage can result in blood clot formation and deciduous scab aggregation, followingly leading to urinary tract obstruction and clot retention. [19,20] The CDC was usually used to classify the grade of complications within 90 days after the operation. [21] Our results showed that the patients with grade I, II, III complication in the HoLEP group were significantly lower than those in the TURP group, and the patients with grade I, II complication in the HoLEP group were significantly lower than those in the PKRP group.…”

Resultados funcionales y complicaciones posteriores a procedimientos quirúrgicos transuretrales para el tratamiento de la obstrucción prostática benigna

“…De acuerdo con nuestra revisión, la RTUP es la cirugía con mayor índice de hemorragia en comparación con las otras técnicas transuretrales, sin embargo, la evidencia apoya que la B-RTUP tiene menores tasas de hemorragia que la M-RTUP. (19) Teniendo en cuenta que la literatura disponible indica que las técnicas endoscópicas conllevan un menor riesgo de sangrado y pueden ser beneficiosas en pacientes con anticoagulantes, se podría recomendar a este tipo de paciente el uso de HoLEP y la resección de la próstata con láser de tulio. Estos datos concuerdan con lo señalado por Rivera et al: HoLEP parece ser un procedimiento seguro y eficaz para los STUI relacionados con la HPB en pacientes que reciben terapia de anticoagulación y terapia antiplaquetaria.…”

Comparison of Emergency Room Visits and Rehospitalization for Bleeding Complications following Transurethral Procedures for the Treatment of Benign Prostatic Hyperplasia: A Population-Based Retrospective Cohort Study

“…PVP and ThuVARP are safer than M-TURP because blood transfusion, clot retention, hemoglobin decline, or transurethral resection syndrome is less likely to occur [ 35 ]. Our findings support changes in the surgical treatment of BPH from M-TURP to new laser methods [ 24 , 36 , 37 ].…”

“…The high CCI score subgroup demonstrated increased HRs for ER visits within 90 days after surgery, whereas patients aged >80 years exhibited a significant risk of bleeding leading to rehospitalization. Our study suggested that laser surgery is safer than M-TURP for BPH because of reduced catheter time and risk of bleeding, even in patients receiving anticoagulant or antiplatelet therapy [ 23 , 35 , 40 ].…”