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Transurethral resection of the prostate in the
Author(s) -
Chakravarti,
Macdermott
Publication year - 1998
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1046/j.1464-410x.1998.00609.x
Subject(s) - medicine , partial thromboplastin time , transurethral resection of the prostate , surgery , urinary retention , prostatectomy , heparin , activated clotting time , warfarin , prothrombin time , regimen , prostate , anesthesia , atrial fibrillation , platelet , cancer
Objective To assess the safety of transurethral prostatectomy (TURP) in patients on long‐term full anticoagulation. Patients and methods Twelve TURPs were performed on 11 patients with urinary retention or severe symptoms from prostatic obstruction who also required anticoagulation for a history of life‐threatening thrombo‐embolic disease (seven) or prosthetic heart valves (four). Patients stopped taking warfarin 3 days before surgery; on admission a day later, full intravenous heparinization was commenced. Heparin was stopped 4 h before TURP and re‐commenced with an initial bolus in the recovery room, and warfarin re‐started that evening. Results The mean weight of prostate resected was 23 g and the mean peri‐operative decrease in haemoglobin was 1.6 g/dL. Only one patient required a transfusion of 3 units, but the activated partial thromboplastin time (APTT) had risen to >4. The mean pre‐ and post‐operative APTT were 1.7 and 2.64, respectively, and the mean total length of hospital stay 6.7 days. Three patients were re‐admitted for secondary haemorrhage at 8, 9 and 28 days after TURP, but all resolved with catheterization for 24 h only. There were no other major complications or thrombo‐embolic phenomena. Conclusion TURP can be conducted safely in this high‐risk group of patients with a regimen that allows a brief but controlled interruption to their full anticoagulation. This protects from the risks of thrombo‐embolic incidents with no major increase in haemorrhage or hospital stay.