Cardiovascular and hematological consequences of transurethral resection of the prostate [a clinical and experimental study]

ABSTRACT

A saline prostate extract was prepared from the prostatic tissue obtained during benign transurethral resection of the prostate [TURP] from several surgical specimens. Forty-eight adult male cats were studied. They were assigned into two main groups Group A [n = 24] in which the cats were heparinized during the experimental procedure for measuring the blood pressure, ECG and serum Na; group B [n = 24] in which the cats were not heparinized and hemoglobin, hematocrit, platelet count, prothrombin time [Pt] and concentration [PC], activated partial thromboplastin [APTT], fibrinogen and fibrinogen degradation product [FDP] were measured at 0, 60, 90 and 120 minutes post infusion. Each of groups A and B were further subdivided into subgroups [six cats each] according to infusion group 1C, saline 15 ml [control for group 1]; group 1, saline prostate extract 15 ml; group 2C, saline 0.5 L/kg [control for group 2]and group 2, glycine 0.5 L/kg. A 90-minute infusion interval was selected for the model to correspond with the maximal infusion period that occurred clinically. Twenty-five patients ASA class I or II were prospectively randomized to undergo TURP under spinal anesthesia. All patients had symptomatic benign prostatic hyperplasia. In conclusion, the experimental work proved that infusion of prostate tissue extract resulted in no statistical or clinical changes in MBP, HG, or ECG; so, it was suggested that glycine is responsible for the cardiovascular changes during TUR syndrome. On the other hand, infusion of prostatic tissue extract resulted in coagulation defects which may contribute to postoperative morbidity. However, the exact mechanism of coagulopathy still needs further investigations to be more specified. Meanwhile, because TURP is one of the most popular urology surgeries in elderly patients all over the world, a care must be taken especially when the size of the gland is over 30-35 g and the duration of surgery is more than 40 minutes