Evaluation of the bleeding risk of transvesical prostatectomy with bladderneck cerclage.

Objective: Evaluation of blood loss and predictive factors of haemorrhagic complications of transvesical prostatectomy. Material and Methods: From January 1994 to December 1998, 202 patients with a mean age of 70.5 +/- 7.4 years (range: 46.6-89.3 years) were operated fo r benign prostatic hyperplasia with a mean prostate weight of 86 +/- 33 g. Transvesical prostatectomy was performed with bladder neck cerclage and suc tion drainage of the prostatectomy site for 48 hours. 107 patients donated blood preoperatively (mean: 2.8 +/- 0.7 units) to allow possible autotransf usion. Blood losses were evaluated by determining haematocrit during hospit alisation, the quantity of blood collected intraoperatively and the presenc e of postoperative bleeding possibly requiring surgical revision. Results: The calculated overall blood loss was 435 +/- 306 ml of RBC, i.e. 1783 ml for an haematocrit of 30%. A high ASA score was significantly relat ed with higher blood loss and preoperative anticoagulant treatment. No pred ictive factor for intraoperative bleeding (mean: 519 +/- 327 ml) was identi fied. Absence of the median lobe and a high ASA score were also predictive factors of postoperative bleeding. Age, operating time, prostate weight, re cent urinary tract infection, preoperative drainage, preoperative haematocr it, and preoperative blood donation (autotransfusion) did not significantly influence the volume of blood loss. Conclusion: Apart from the ASA score, no predictive factor for the severity of bleeding associated with transvesical prostatectomy was defined in orde r to identify a group of patients at higher risk of severe bleeding.