Is Routine Measurement of Post-operative Hemoglobin and Electrolytes Necessary in Every Patient After Transurethral Resection of the Prostate?

157 ORIGINAL RESEARCH ©Copyright 2018 by the Association of Urological Surgery / Journal of Urological Surgery published by Galenos Publishing House. What’s known on the subject? and What does the study add? Correspondence: Muhammad Hammad Ali Mithani MD, The Kidney Centre Post Graduate Training Institute, Department of Urology, Karachi, Pakistan E-mail: dr.hammad.mithani@gmail.com ORCID-ID: orcid.org/0000-0002-2166-7248 Received: 23.03.2018 Accepted: 12.06.2018 Cite this article as: Mithani MHA, El Khalid S, Khan SA, Sharif I, Awan AS. Is Routine Measurement of Post-operative Hemoglobin and Electrolytes Necessary in Every Patient After Transurethral Resection of the Prostate? J Urol Surg 2018;5(4):157-164. Öz Amaç: Transüretral prostat rezeksiyonu (TURP) sonrası, hastalarda postoperatif hemoglobin ve elektrolit izleminin önemini değerlendirmek ve izlem için dikkate alınması gereken parametreleri belirlemektir. Objective: To evaluate the importance of post-operative hemoglobin and electrolyte monitoring after transurethral resection of the prostate (TURP) and establish the parameters to be considered for monitoring. Materials and Methods: Data of patients who underwent TURP between 2007 and 2017 were reviewed. Data regarding prostate size, irrigation fluid volume, resection time, preand post-operative electrolytes, hemoglobin levels taken within 48 hours before and after surgery, and blood transfusion information were collected. In order to establish parameters for post-operative laboratory monitoring, we categorized prostate size, resection time, and irrigation fluid into groups i.e. (<45 g, 45-60 g, 61-80 g and >80 g), (<30 min, 31-60 and >60 min) and (<20 L, 21-40 L and >40 L) respectively. Results: A total of 1.000 patients were included. The median age was 66 years with the minimum of 46 years and maximum of 98 years. The median prostate size was 54.26 g. Among all preand post-operative laboratory parameters, only hemoglobin and sodium showed a significant change, which were analyzed further. Drop in hemoglobin was significantly associated with increasing prostate size and volume of irrigation fluid. Patients with a prostate size of >80 g had 27.3 times higher chance of significant (>2 g) drop in hemoglobin while 5.1 times higher when irrigation volume exceeded 40 liters. Low levels of sodium were strongly associated with prostate size, irrigation fluid volume, and resection time. However, all these factors become insignificant (p≥0.05) for their effect on low sodium, when these variables were adjusted with each other. Blood transfusion was performed in 27 patients. All these patients belonged to a group of patients with prostate size of more than 80 g with high resection time and irrigation fluid volume. Three patients had TUR syndrome. Post-operative hemoglobin and electrolytes monitoring contributed to a change in the management of only 14% of patients. Conclusion: Routine post-operative hemoglobin and electrolyte measurement is not required in every patient undergoing TURP. Use of risk stratification approach will help us to decide which patient needs post-operative lab testing.