Autologous blood donation prior to anatomical radical retropubic prostatectomy: is it necessary?

OBJECTIVES: To determine if autologous blood donation prior to anatomical radical retropubic prostatectomy, given current improvements in surgical technique, is necessary. METHODS: The medical records of 200 consecutive patients undergoing radical retropubic prostatectomy for clinically localized prostate cancer were reviewed with regard to (1) preoperative hematocrit (HCT); (2) estimated blood loss (EBL); (3) postoperative HCT prior to discharge; (4) number of units of autologous blood donated; and (5) number of units of autologous and homologous blood transfused. In addition, the charges associated with autologous blood donation were determined via telephone interview with 14 blood donation centers across the United States. RESULTS: Overall, 189 patients (95%) did not require a homologous blood transfusion. Sixty-four patients (32%) donated autologous units and 136 patients (68%) did not. Of the patients who had donated, only 17 (27%) received their blood back, and none (0%) received any homologous blood. Eleven (8%) of the 136 nondonors received a blood transfusion. The autologous donors, in comparison with nondonors, were found to have a significantly lower preoperative HCT (mean +/- standard deviation: 40 +/- 4.0% versus 42 +/- 2.9%, P < 0.05). However, there was no statistically significant difference in the mean EBL between the two groups, autologous donors versus nondonors (771 +/- 370 versus 737 +/- 425 cc, P = 0.23). The autologous donors had a smaller mean change in HCT versus the nondonors (-9.3 +/- 5.1% versus -11.2 +/- 4.4%, P < 0.05), reflecting an increased willingness to transfuse patients who have autologous units available. With regard to cost, patients, on average, can expect to be charged as much as $745 per unit of autologous blood donated. CONCLUSIONS: These findings suggest that preoperative blood donation prior to radical prostatectomy may not be necessary, because 95% of the patients did not require a homologous blood transfusion. In addition, autologous blood donation can be associated with substantial costs in both time and money. Thus, autologous donation should be left as an option for the patient and should not be considered routine practice.

Urinary tract status of patients with neurogenic dysfunction presenting with upper tract stone disease.

We treated 71 patients with neurogenic vesical dysfunction between September 1983 and June 1990 for upper tract stones. We studied these patients to determine the time course of stone development and the presence of associated urological abnormalities. There were 44 male and 27 female patients 6 to 72 years old. Lower urinary tract dysfunction resulted from spinal cord injuries in 34 patients (48%), myelodysplasia in 19 (27%), multiple sclerosis in 12 (17%) and other diagnoses in 6 (8%). Of 71 patients 21 (30%) were managed by an ileal loop, 12 (17%) by a Foley catheter, 10 (14%) by a suprapubic tube, 10 (14%) by ureterostomy, 5 (7%) by vesicostomy, 8 (11%) by intermittent catheterization, and 5 (7%) by diaper, Créde's voiding or condom catheterization. Stone disease developed within 1 to 22 years. Patients with an indwelling catheter or supravesical diversion fared worse than those managed by intermittent catheterization or vesicostomy; they had higher rates of renal unit loss, renal parenchymal damage, decreased renal function, hydroureter, and staghorn and bilateral calculi. All of the listed methods of management were contemporaneous, suggesting the continued use of methods proved to be associated with upper tract deterioration.

Iatrogenic lithotripsy failure: penetration of shock waves through tape.

Foam tape used to protect epidural catheters during immersion in a Dornier HM3 lithotriptor was identified retrospectively as the cause of poor stone fragmentation. Studies of shock wave penetration through various protective type materials indicate that a particular water repellant tape is least likely to impair shock wave penetration.