Immediate Transurethral Plasma Kinetic Enucleation of the Prostate Gland for Treatment of Benign Prostatic Hyperplasia-Associated Massive Hemorrhage: A Single-Center Experience.

Yu Gan,Qiangrong He,Liang Deng,Chao Li,Leye He,Zhi Long

doi:10.3389/fsurg.2021.810175

Abstract

Purpose: Benign prostatic hyperplasia-associated massive hemorrhage is a urological emergency. We evaluated the outcome from immediate transurethral plasma kinetic enucleation of the prostate gland (i-TUPKEP) for BHM treatment.Methods: We retrospectively analyzed the records of 49 patients with acute BMH who underwent i-TUPKEP between January 2014 and November 2018 at our institution. The hemostatic effect, International Prostate Symptom Score (IPSS), and quality of life (QoL) score were evaluated preoperatively as well as 3, 6, and 12 months postoperatively. Postoperative follow-up also included measurement of the peak flow rate (Qmax) and post-void residual urine volume (PVR). Clinical characteristics, weight of resected tissue, duration of bladder irrigation, duration of hospital stay, complications, as well as the time required for enucleation and resection, were recorded.Results: BMH causes were attributed to transurethral surgery (17/49, 34.7%), violent catheterization (13/49, 26.5%), cystoscopy (10/49, 20.4%), and urethral dilatation (9/49, 18.4%). Bleeding was from different sites of prostate-gland tissues during i-TURKEP. i-TUPKEP-controlled BMH effectively induced immediate, notable, and lasting improvements in the IPSS and QoL score. Qmax was close to normal, and the PVR was within the physiological range, postoperatively. Long-term complications were not observed.Conclusion: Our preliminary data suggest that i-TUPKEP is a feasible method for controlling BHM and relieving BPH symptoms.

Highlights

Hematuria is a common complication of benign prostatic hyperplasia (BPH), which is often caused by injury to the prostatic urethra and gland [1]
After accumulating sufficient experience in using TUPKEP for BPH, we explored the efficacy and safety of TUPKEP for controlling BPH-associated massive hemorrhage (BMH)
Of the 17 patients who had a history of TURP, eight patients (8/17, 47.1%) had received an emergency transurethral procedure one to two times to control bleeding and to clear blood clots before being transferred to Third Xiangya Hospital

Summary

Introduction

Hematuria is a common complication of benign prostatic hyperplasia (BPH), which is often caused by injury to the prostatic urethra and gland [1]. Mild bleeding can be controlled through conservative treatment methods [2, 3], massive hemorrhage due to transurethral examination and/or surgery can develop into a urological emergency [4, 5]. Persistent blood loss without effective control can induce cardiovascular and cerebrovascular complications or lead to hemorrhagic shock and, sometimes, death [6, 7]. Eliminating blood clots from the bladder and controlling BPH-associated massive hemorrhage (BMH) at the earliest opportunity is crucial. Transurethral resection of the prostate gland (TURP) is a minimally invasive method to treat BMH. Residual prostatic tissue after TURP in this setting is likely to become a new bleeding site. Patients have to undergo another surgical procedure to stop the bleeding, which leads to an overall increased risk of complications [5, 6]

Methods

Results

Conclusion