Measurement and quantitative analysis of perioperative blood loss and associated clinical variables in patients undergoing transurethral resection of the prostate: a prospective observational study.

INTRODUCTION: Perioperative bleeding is a clinically important adverse outcome of transurethral resection of the prostate (TURP), the gold standard surgical procedure in the management of benign prostatic hyperplasia (BPH). The difficulty in quantifying blood loss is because there is constant irrigation in the procedure. This research attempted to objectively estimate perioperative blood loss by hemoglobin and determine clinical and procedural predictors of elevated perioperative blood loss. METHODS: It is a prospective observational cohort study that includes at least 60 male patients who were ≥ 50 years old undergoing elective TURP in two urology centers in Sulaymaniyah, Iraq. The preoperative and 24-hour postoperative hemoglobin were measured and the clinical variables were registered, such as age, comorbidities, PSA, prostate volume, and operative time. Paired t-tests, Pearson correlation and multivariate logistic regression were used as statistical analysis. RESULTS: Mean hemoglobin decreased markedly from 13.8 to 13.2 g/dL, (p < 0.001) with an approximate median blood loss of 5.7%. PSA level was the most correlated with blood loss (r = 0.307, p < 0.01), then prostate size and operative duration. The risk of hemorrhage was also linked to comorbidity status. Multivariate analysis showed no individual predictor of high blood loss. CONCLUSIONS: Hb-based quantification is a valid, clinically viable method for quantifying perioperative blood loss in TURP. The process of bleeding is multifactorial with PSA, prostate size, and operative duration being the main correlates. Strong preoperative risk stratification is needed to optimize perioperative care and surgical safety.