Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP).
BACKGROUND
Intractable haemorrhage after endoscopic surgery, including transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP), is uncommon but a significant and life-threatening problem. The knowledge and technical experience to deal with this complication may not be wide-spread among urologists and trainees. We describe our series of TURPs and PVPs and the incidence of postoperative bleeding requiring intervention.


METHODS
We retrospectively reviewed 437 TURPs and 590 PVPs over 3 years in our institution. We describe the conservative, endoscopic and open prostatic packing techniques used for patients who experienced postoperative bleeding.


RESULTS
Of 437 TURPs, 19 required endoscopic intervention for postoperative bleeding. Of 590 PVPs, two patients were successfully managed endoscopically for delayed haemorrhage at 7 and 13 days post-surgery, respectively. In one TURP and one PVP patient, endoscopic management was insufficient to control postoperative haemorrhage and open exploration and packing of the prostatic cavity was performed.


CONCLUSIONS
Significant bleeding after endoscopic prostatic surgery is still a potentially life-threatening complication. Prophylactic measures have been employed to reduce peri-operative bleeding but persistent bleeding post-endoscopic prostatic surgery should be treated promptly to prevent the risk of rapid deterioration. We demonstrated that the technique of open prostate packing may be life-saving.
Department of Urology, King's College Hospital, London, UK.
Mark
M
Lynch
Seshadri
S
Sriprasad
Kesavapillai
K
Subramonian
Peter
P
Thompson
D001458:Bandages; D004724:Endoscopy / Q000379:methods; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000009:adverse effects* / Q000379:methods