title: New perioperative management reduces bleeding in radical retropubic prostatectomy.
abstract: OBJECTIVE
  To describe the effect of modifications to radical retropubic prostatectomy (RRP, known to be associated with severe bleeding) on blood loss in a retrospective analysis comparing RRPs by one experienced surgeon before and after the changes.
  
  
  METHODS
  The new method comprised reducing the intravenously applied volume, using a peridural catheter and maintaining a 25-30 degrees Trendelenburg position. The difference in haemoglobin before and after RRP was analysed before the changes (group 1) and after (group 2). If transfusions were required the haemoglobin value was corrected, whereby 1 mL of erythrocyte concentrate increased the patient's haemoglobin by 0.03 g/L.
  
  
  RESULTS
  Assessment was possible in 201 of 234 patients, 110 from group 1 and 91 from group 2. The mean transfusion-corrected difference in haemoglobin was 53 g/L in group 1 (20% transfusion rate) and 35.2 g/L in group 2 (1.09% transfusion rate; P > 0.001). The median intravenous volume applied was 5.96 L in group 1 and 3.49 L in group 2 (P < 0.001). The complication rate did not differ between the groups.
  
  
  CONCLUSIONS
  This new method minimizes the intraoperative blood loss during RRP; transfusions are only necessary in rare cases and the complication rate remained unaltered.
authors.affiliation: Department of Urology, Charité-Campus Benjamin Franklin, Universitätsmedizin Berlin, Germany. martin.schostak@charite.de
authors.forename: Martin
authors.initials: M
authors.lastname: Schostak
authors.forename: Klaudia
authors.initials: K
authors.lastname: Matischak
authors.forename: Markus
authors.initials: M
authors.lastname: Müller
authors.forename: Michel
authors.initials: M
authors.lastname: Schäfer
authors.forename: Mark
authors.initials: M
authors.lastname: Schrader
authors.forename: Frank
authors.initials: F
authors.lastname: Christoph
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001810:Blood Volume; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins; D017430:Prostate-Specific Antigen