COAGULATION DISORDERS AFTER ENDOSCOPIC RE SECTION OF THE PROSTATE

Endoscopic resection of the prostate is a well defined surgical proced ure. Nevertheless, certain coagulation disorders (hypercoagulability w ith risk of deep vein thrombosis, haemorrhage) can raise special probl ems. In patients not given heparin prophylaxis, the incidence of deep vein thrombosis is 10% in transurethral resections of the prostate (TU RF). The risk is higher for cancer. Among the diagnostic tools (D-dime r assay, continuous Doppler, pulsed echo-Doppler, thermography, plethy smography, ...) ascending phlebography or plumonary angiography in cas e of suspected pulmonary emboli remains the gold standard. Haemorrhage is rarely related to defribination but frequently to dilution coagulo pathy favoured by high blood pressure, resorption of irrigation fluid, deficient haemostasis with loss of coagulation factors or massive tra nsfusions. Only clinically patent coagulation disorders leading to hae morrhage should be treated. For dilution coagulopathies and diffuse in travascular coagulation, treatment is based on viro-inactived fresh pl asma infusion. Aprotinine is the first choice in case of fibrinolysis