Bloodless urological surgery: A retrospective study

The refusal of blood transfusion by Jehova's Witnesses (JW) stimulated the development of problem-oriented anesthesiological and surgical techniques. A pioneer of bloodless surgery was Cooley at the Texas Heart Institute in t he Sixties. However, up to now, urological surgery of JW has not been evalu ated systematically. Here in our experience in 70 JW is reported in a retro spective study. Patients and methods: A total of 61 adults (average age 61 years) and 9 chi ldren (median age 6.23 years) underwent 80 urological procedures: Preoperat ively, the hematological findings were normal in 81.3% of the adults and in all children. Despite a normal PTT, 2/61 adults had a prothrombin time of 30% and 60%, respectively. 30/80 operations were classified as prone to blo od loss (PBL). 17/30 were radical retropubic prostatectomies (RRP), among t he less endangered were 17 transurethral resections of the prostate (TURP). Only 7% of the patients with PBL interventions were without risk factor (e .g. diabetes), but 91.7% were grouped as ASA class 1 or 2, the remaining pa tients as ASA class 3. The ethico-legal requirements were met in all 61 JW. In patients subjected to open surgery the compartment technique was carrie d out. Results: In all 9 children the perioperative course was uneventful. In 13% of the adults with non-PBL-procedures the blood pressure fell to 60/40 not accompanied by a drop in hemoglobin; ail had a TURP. The hospital stay last ed an average of 10.5 days. In the 30 PBL-operations, the time required was 2.5 hours, but in patients with a high risk of bloodless (24/30) the time was 3.4 hours. 29.2% had a peridural anesthesia plus intubation, 10% had co ntrolled hypotension. In 92% of the high-risk patients the hemoglobin fell below the lower normal limit. Two female patients tolerated a hemoglobin na dir of 5.0 and 4.9 g/100 ml, respectively, without complications. One patie nt succumbed to an autopsy-proven pulmonary embolism. The hospital stay in PBL-patients lasted 19.5 days, in high-risk patients 23.9 days. Conclusion: In keeping with the experience reported in the literature, this study demonstrated that bloodless surgery is feasable even in major urolog ical surgery.