The Possibility of Forecast an Expressed Intraoperative Bleeding During Transurethral Resection of the Prostate using Preoperative Transrectal Ultrasound

Abstract

There is no doubt about the prevalence rate of benign prostate hyperplasia. Currently, transurethral prostate resection (TUR) is the main method of surgical treatment. To clarify the degree of possible intraoperative bleeding, we assume the application of pre-hospital transrectal ultrasonic prostate examination (TRU) with vascular Doppler and 2D Shear Wave elastography.The aim: to evaluate the possibilities of preoperative complex TRU prostate examination in forecasting of the expressed intraoperative bleeding.Materials and methods. The study included the results of a survey of 242 patients in the urological Department of the road clinical hospital of Rostov-on-don in the period from 2016 to 2017, which had undergone TUR of the prostate. All patients before the operation was performed prostate transrectal ultrasonography (TRU) with Doppler and 2D Shear Wave Elastography (2DSWE). Depending on the amount of blood loss determined after surgery, all patients were divided into three statistically (p < 0.001) significant groups (р < 0.001). All TRU examinations were made with ultrasound system Aixplorer (France). During Doppler sonography, maximal linear blood flow velocity (Vmax) in capsular arteries (CA), in “surgical capsule” arteries (SCA) and in the paraurethral artery (PuA) was measured. During 2D Sheare Wave elastography (2D SWE) stiffness of tissues was measured (in kPa) in symmetric areas of both lobes of peripheral zone (PPZ), central zone (CZ), and transitory zone (TZ) of prostateResults. Significant (p < 0.001) correlation of blood loss with reduction of hemoglobin level, as well as with Vmax CA, Vmax PuA, tissue stiffness TZ and areas on the border with the surgical capsule revealed. The ROC analysis showed, that sensitivity and specificity of predictions of severe intraoperative blood loss, when using a cut-off for the Vmax of the blood flow in CA more 18.7 cm/s, was respectively 87.2% and 94.4 per cent; when using a cut-off for the Vmax of the blood flow in the basin PUA over 24.2 cm/s – respectively of 76.6% and 78.5%; when using a cut-off of stiffness of the tissues TZ less of 39.8 kPa – respectively 100% and 95.4%: when using a cut-off of stiffness of the tissues at the border of the “surgical capsule” less than the 38.1 kPa – respectively 89,4% and 90,8%.Conclusion.The use of cut-off Vmax values for the blood flow in the paraurethral and capsular arteries, as well as the use of cut-off values for tissue stiffness in the prostate transitory zone of prostate and in the surgical capsule area, may be an effective means of forecasting of expressed intraoperative bleeding. The data presented is recommended to take into account the operating surgeon during the selection of patients for operative benefits.