Editorial comment

Abstract

The issue of either spontaneous bleeding due to BPH or intraoperative and perioperative bleeding, occasionally requiring blood transfusions, has been an integral part of virtually all surgical series for this condition whether they describe open prostatectomy by the suprapubic or retropubic route or TURP. The 1994 Agency for Health Care Policy and Research (AHCPR) “Clinical Practice Guidelines for the Diagnosis and Treatment of Benign Prostatic Hyperplasia” established weighted averages for the need for intervention for bleeding (irrigation, return to operating room for exploration or cystoscopy) and for the need of blood transfusion based on an exhaustive literature review performed in the early 1990s (Table III). It is quite clear that the incidence of intraoperative and perioperative bleeding and the need for blood transfusion are significantly reduced since the publication of most of the series included in the analysis. However, intraoperative bleeding still constitutes a major problem for residents-in-training who have fewer and fewer opportunities to refine their technique of TURP. Postoperative bleeding and need for either catheterization, clot evacuation, or return to the operating room remains a problem, and the estimate made by the AHCPR Guidelines panel of 2.2% is most likely not too far off. Even in the hands of experienced resectionists, it is likely that 1 of every 50 patients will have a problem with postoperative bleeding and/or clots, requiring either a visit to the emergency room or a return to the operating room. TABLE IIIBleeding complications after surgery legend Key: TUIP = transurethral incision of the prostate; TURP = transurethral resection of the prostate. Intervention Bleeding Intervention Blood Transfusion n Weighted Average (%) n Weighted Average (%) Open prostatectomy 7761 1.5 6989 35.1 TUIP 1226 0.5 1243 1.2 TURP 7184 2.2 7603 12.5 legend Key: TUIP = transurethral incision of the prostate; TURP = transurethral resection of the prostate. Open table in a new tab