Urination Problems After Procedure in a Man Treated for BPH

Darshan Rola; Brian Zacharias; Neal Patel; Dhiaeddine Djabri; Alexandra Gabro; Alex T. Villacastin, MD

Disclosures

April 01, 2022

Clot retention with major bleeding remains one of the most common complications of TURP.[5] The American College of Chest Physicians and the American Urological Association have identified TURP as posing a high risk for bleeding complications in the setting of perioperative antithrombotic therapy.[6,7] The patient in this case had a history of coronary artery disease and percutaneous coronary intervention with stent placement. He was receiving dual antiplatelet therapy with aspirin and clopidogrel for the prevention of stent thrombosis. It takes up to 10 days to completely replete the population of platelets of a patient on antiplatelet agents. Thus, the American Urological Association recommends the discontinuation of antiplatelet agents 7-10 days prior to TURP.[7] Because antiplatelet therapy was discontinued only 2 days before the procedure in this case, it may have exacerbated the patient's symptoms, which led to an increased risk for complications.

In the patient in this case, cystoscopy revealed clot retention at the prostatic fossa, which is consistent with his presentation with obstructive uropathy and acute urinary retention after TURP. After the clot evacuation, active bleeding was noticed at the anterior surface of the bladder neck, at multiple points within the prostatic fossa posteriorly, and at the anterior apex. Hemostasis was subsequently achieved with rollerball electrode fulguration. The patient's Foley catheter was discontinued the next day, with no further episodes of hematuria or LUTS. His hemoglobin level had dropped from 7.7 g/dL on admission to 7 g/dL after the cystoscopy. He received 2 units of packed RBCs and was subsequently discharged once a hemoglobin level of 9.2 g/dL had been achieved.

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