Management of Post-TURP Bleeding

Initial Management

• Immediate management of post-TURP bleeding requires continuous bladder irrigation with a large-caliber urethral catheter (20-24 Fr), and if conservative measures fail, proceed directly to endoscopic intervention with fulguration of bleeding vessels, reserving arterial embolization or open prostatic packing for refractory cases 1, 2

Special Considerations for Anticoagulated Patients

• Patients on warfarin should be bridged with LMWH perioperatively, with LMWH held 24 hours before surgery and resumed at least 24 hours postoperatively or when bleeding has subsided 3, 4
• Delay resumption of anticoagulation by 24-48 hours if any concern for ongoing bleeding exists 4
• Patients on antiplatelet therapy (aspirin) have only modestly increased minor bleeding without significantly increased transfusion requirements 4

Management of Hematuria After TURP

Anticoagulation Management

• The American Urological Association recommends holding warfarin and reversing anticoagulation if bleeding is significant in patients on warfarin 5
• For patients on bridging low molecular weight heparin (LMWH), ensure it was held 24 hours preoperatively to minimize bleeding risk 6
• Patients on aspirin have a modestly increased minor bleeding risk but without significantly increased transfusion requirements, and bleeding is typically manageable with conservative measures 5
• Novel oral anticoagulants (NOACs) such as apixaban, dabigatran, and rivaroxaban should be discontinued 2-5 days before TURP depending on bleeding risk, and consider specific reversal agents if bleeding occurs 5