Question

Management of bleeding during and after TUR-P.

Hint:

Ensuring proper hemostasis during TUR-P is critical, and using modern techniques such as bipolar resection and laser treatment can significantly reduce the risk of postoperative bleeding.

Answer 1

Step 1: Preoperative Management:
To minimize bleeding during and after transurethral resection of the prostate (TUR-P), careful preoperative management is essential:
- Anticoagulation management: Anticoagulants should be stopped before the procedure, and alternative measures such as heparin bridging therapy may be considered.
- Preoperative hydration: Proper hydration reduces the risk of bleeding by maintaining blood pressure and circulation.
- Cauterization and laser use: Using electrocautery or lasers during the TUR-P procedure helps to minimize bleeding by coagulating blood vessels.

Step 2: Intraoperative Management:
Intraoperative management aims to control bleeding during the procedure:
- Cautery and Bipolar TUR-P: The use of bipolar energy helps reduce the risk of bleeding, especially for patients on anticoagulation.
- Continuous irrigation: Normal saline or glycine irrigation is used during the procedure to keep the surgical site clear and prevent clot formation.

Step 3: Postoperative Management:
After TUR-P, managing bleeding includes:
- Bladder irrigation: Continuous bladder irrigation with normal saline to flush out blood clots.
- Hemostasis agents: In case of excessive bleeding, topical hemostatic agents or local cauterization may be applied to stop bleeding.
- Monitoring and transfusion: Close monitoring of hemoglobin levels is essential, and blood transfusions may be required in cases of significant blood loss.