Presented by: Alvin Lee MBBS, MRCS
Singapore General Hospital

Introduction

The objective of our study was to evaluate the impact of preoperative prostate artery embolisation (PAE) on intraoperative blood loss during transurethral resection of the prostate (TURP) in glands larger than 80cc.

Materials

A prospective, surgeon-blinded randomised controlled clinical trial was conducted at a single tertiary centre. Patients with prostate volume more than 80cc with indications for TURP were randomised (1:1) to pre-operative prostatic artery embolization followed by TURP (Group A - intervention arm) versus TURP alone (Group B - control arm). The primary outcome studied was blood loss measured as absolute reduction in haemoglobin post-operatively and secondary outcomes measured were resection efficiency (resected weight per min) and post-operative complication rate.

Results

,

Our study included 10 patients each in Group A and B. Median prostate volume was 119 mL versus 140 mL and median pre-operative haemoglobin was 13.3 g/dL (IQR 12.5 – 14.3 g/dL) versus 14.4 g/dL (IQR 10.1 – 15.2 g/dL) in Group A and B respectively. Change in post-operative haemoglobin was significantly greater in Group B compared to Group A (-1.4 g/dL vs +0.5g/dL, p=0.015). There were no significant differences between the percentage of prostate weight resected (56% vs 48%, p=0.151) and resection efficiency (0.7 g/min versus 0.6 g/min, p=0.853) between group A and B. Two patients in Group B received one unit of red blood cell transfusion compared to only 1 patient in Group A (p=1.00). One patient from each group had to be brought back to the operation room for haemostasis.

Conclusion

Pre-operative PAE reduced intra-operative blood loss in men with large prostate glands undergoing transurethral resection of prostate but did not impact resection efficiency nor complication rate.

Funding

Nil

Co-Authors

Shu Hui Neo, MBBS, FAMS
Sengkang General Hospital

Tze Kiat Ng, MBBS, FRCS, FAMS
Singapore General Hospital

Edwin Jonathan Aslim, MBBS, MRCS, FAMS
Singapore General Hospital

Yufei Qiao, MD
Singapore General Hospital

Allen Sim, MBBS, MRCS, FAMS
Gleneagles Medini Johor

Pradesh Kumar, MB ChB (Dundee), MRCS (Glasg) FRCR (UK), CCT (UK)
Sunway Medical Centre

Sivanathan Chandramohan, MBBS, MRCS, FRCR, EBIR
Singapore General Hospital

John Yuen, ​MBBS (Melb), MMed (Surg) (S'pore), MRCS (Edin), FAMS (Urology), DPhil (Oxon)
Singapore General Hospital

Kenneth Chen, ​MBBS (S’pore), MRCS (Edin), MCI, DFD (CAW), FRCS (Glas), FAMS (Urol)
Singapore General Hospital