TRANSURETHRAL RESECTION OF THE PROSTATE IN THE ANTICOAGULATED PATIENT

Objective To assess the safety of transurethral prostatectomy (TURP) i n patients on long-term full anticoagulation. Patients and methods Twe lve TURPs were performed on 11 patients with urinary retention or seve re symptoms from prostatic obstruction who also required anticoagulati on for a history of life-threatening thromboembolic disease (seven) or prosthetic heart valves (four). Patients stopped taking warfarin 3 da ys before surgery: on admission a day later, full intravenous heparini zation was commenced. Heparin was stopped 4 h before TURF and re-comme nced with an initial bolus in the recovery room, and warfarin re-start ed 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. Onl y one patient required a transfusion of 3 units, but the activated par tial 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 le ngth of hospital stay 6.7 days. Three patients were re-admitted for se condary haemorrhage at 8, 9 and 18 days after TURF, but all resolved w ith catheterization for 24 h only, There were no other major complicat ions or thrombo-embolic phenomena, Conclusion TURF can be conducted sa fely in this highrisk group of patients with a regimen that allows a b rief but controlled interruption to their full anticoagulation, This p rotects from the risks of thromboembolic incidents with no major incre ase in haemorrhage or hospital stay.