title: [New concept minimizes bleeding in radical retropubic prostatectomy].
abstract: BACKGROUND
  Radical retropubic prostatectomy is an intervention known to be associated with severe bleeding. Even experienced surgeons report a blood transfusion rate of up to 20%. The perioperative concept for this intervention underwent various modifications in January 2001. This study describes the effect of these modifications on the blood loss in a retrospective analysis comparing approximately 100 operations by a single experienced surgeon before the change (group 1) with 100 operations thereafter (group 2).
  
  
  METHODS
  The new perioperative concept comprised the following points: reducing the intravenously applied volume, employing a peridural catheter (PDC), and maintaining a 25-30 degrees Trendelenburg's position. The difference in pre- and postsurgical hemoglobin (Hb) was analyzed before (group 1) and after the intervention (group 2). If transfusions were performed, this value was corrected according to the following formula: 1 ml of erythrocyte concentrate increases the patient's Hb by 0.003 g/dl.
  
  
  RESULTS
  Assessment was possible in 201 of 234 cases, 110 from the first and 91 from the second group. The mean transfusion-corrected Hb difference was 5.3 g/dl in group 1 (20% transfusion rate) and 3.52 g/dl in group 2 (1.09% transfusion rate); p>0.0001. The median intravenous volume applied was 5.960 ml in group 1 and 3.490 ml in group 2 (p>0.0001). The complication rate did not differ between groups.
  
  
  CONCLUSIONS
  The new perioperative concept minimizes the intraoperative blood loss during radical open retropubic prostatectomy. Transfusions are only necessary in rare cases. The complication rate remains unaltered.
authors.affiliation: Urologische Klinik und Poliklinik, Charité -- Campus Benjamin Franklin, Universitätsmedizin, Berlin. martin.schostak@charite.de
authors.forename: M
authors.initials: M
authors.lastname: Schostak
authors.forename: K
authors.initials: K
authors.lastname: Matischak
authors.forename: M
authors.initials: M
authors.lastname: Schäfer
authors.forename: M
authors.initials: M
authors.lastname: Müller
authors.forename: M
authors.initials: M
authors.lastname: Schrader
authors.forename: F
authors.initials: F
authors.lastname: Christoph
authors.forename: K
authors.initials: K
authors.lastname: Miller
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data*; D015897:Comorbidity; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods* / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome