An improved technique for controlling bleeding during simple retropubic prostatectomy: a randomized controlled study.
OBJECTIVE
To compare two techniques of open prostatic adenectomy (OPA) for controlling bleeding, as OPA is the most effective surgical method for alleviating obstructive symptoms related to benign prostatic hyperplasia (BPH) but there is always a risk of peri-operative bleeding.


METHODS
The study comprised a prospective and randomized analysis of 62 men with BPH who consecutively had OPA between January 2002 and September 2004. Two techniques were used: in group 1, patients had the Millin modified retropubic prostatectomy, and in group 2 they had a classical transvesical prostatectomy. Blood loss during and after surgery was analysed.


RESULTS
The median (range) blood loss during surgery was 362 (50-700) and 640 (200-1500) mL for groups 1 and 2, respectively (P = 0.007). The mean (sd) decrease in haemoglobin level from before to 1 day after surgery was 1.76 (0.31) and 3.15 (0.33) g/dL for groups 1 and 2, respectively (P < 0.001). When comparing the first and third days after surgery, there were no further significant decreases in levels for group 1, at 0.15 (0.31) g/dL (P = 0.175), but there was a significant decrease for group 2, at 0.74 (0.33) g/dL (P = 0.031). There was a similar decrease in haematocrit levels. While three patients from group 2 required a blood transfusion, only one from group 1 had to be transfused.


CONCLUSIONS
The Millin technique, as modified by one of the present authors, can significantly control bleeding during and after surgery, and reduce transfusion rates, when compared to the classic transvesical prostatectomy.
Dall'Oglio
Marcos F
MF
Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Srougi
Miguel
M
Antunes
Alberto A
AA
Crippa
Alexandre
A
Cury
José
J
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*
D006454:Hemoglobins