Benign prostatic hyperplasia (BPH) is a common condition affecting the males with age group of more than 50 years. The gold standard of treatment for BPH is transurethral resection of the prostate (TURP). However, complications like bleeding and TURP syndrome are well known with TURP. Tranexamic acid (TNXA) is synthetic antifibrinolytic helps in reducing blood loss. Its use has been done intravenously in the various urological procedures till date. However, concerns about the safety of systemic administration of tranexamic acid and the risk of thromboembolic events such as deep–vein thrombosis or pulmonary embolism restrict its usage. In our study we have, used TNXA as a topical agent with the irrigation fluid during TURP. This study is the first of its kind in literature.

MATERIALS AND METHODS

A prospective randomized control trial was conducted by the department of Urology and Anesthesiology with 60 men in the age group of 50–75yrs who underwent TURP at St Johns medical college and hospital, Bangalore, Karnataka, India from Oct 2016 – July 2017. They were randomized into 2 groups of 30 each as study (group A) and control(  group B).In the study group, TNXA was added in irrigation fluid and control group included patients in which irrigation fluid without TNXA was used . Serum hemoglobin was measured preoperatively and 2 hours after surgery, the volume and hemoglobin concentration of irrigation fluid, resected prostate weight and duration of resection was noted.

RESULTS

Mean hemoglobin in group A was 12.7gm/dl whereas in group B was 12.5. In group A, the average blood loss intraoperatively was 145.4 ml while in Group B was 197.5 ml, P value < 0.05 – statistically significant. The amount of hemoglobin lost per gram of resected tissue was 0.032grams in group A and 0.062grams in Group B (P value < 0.05 – statistically significant).  Operative time was almost same in both the groups. However intraoperative vision was better with Group A owing to less intraoperative bleeding.

CONCLUSION

TNXA when used as a topical agent during TURP with the irrigation fluid decreases the blood loss and hemoglobin fall per gram of prostatic tissue resected. Although there was no effect on the operative time or fluid volume used, it definitely led to better vision during surgery.