Comparative Study of the Effects of Local Tranexamic Acid (TXA) and Placebo in Reducing Bleeding in Patients Undergoing TURP Surgery

Abstract

Background: Benign prostatic hyperplasia (BPH) is common in older men and is associated with reduced quality of life and increased healthcare costs. Transurethral resection of the prostate (TURP), as a standard surgical treatment, is associated with a significant risk of bleeding, partly due to activation of local fibrinolytic pathways. Although tranexamic acid (TXA) has been shown to reduce bleeding in various surgical settings, the efficacy of topical TXA administered via irrigation fluid during TURP remains controversial. Objectives: The aim of this study was to investigate the effect of topically administered TXA in irrigation fluid on TURP-related intraoperative and postoperative bleeding. Methods: A clinical study including 54 patients who were candidates for TURP was conducted in the urology clinic of Golestan Hospital, Ahvaz, over a period of one year. Patients were randomly divided into two groups: TXA and control. Prostate volume, hemoglobin, blood pressure, estimated intraoperative blood loss, irrigation fluid volume, operative time, and the need for transfusion during and after the procedure were recorded. Results: Baseline characteristics of the patients in the two groups were similar (age, prostate volume, hemoglobin, and blood pressure; P > 0.05). The decrease in hemoglobin at 24 hours after surgery was less in the TXA group than in the control group (P = 0.04). Intraoperative blood loss was significantly lower in the TXA group compared with the control group (P = 0.03). Conclusions: Baseline characteristics showed that the two groups were homogeneous in age, prostate volume, hemoglobin, and blood pressure. Hemoglobin decreases at 24 hours post-surgery and intraoperative bleeding were lower in the TXA group than in the placebo group, while lavage volume and operation duration did not differ. These findings suggest an association between topical TXA use and reduced perioperative bleeding during TURP; however, further studies using adjusted statistical models are required to confirm an independent effect.