Post-TURP Hematuria Management

Initial Assessment and Management

The American Urological Association (AUA) guidelines recommend obtaining a complete blood count to quantify blood loss and guide transfusion decisions in patients with post-TURP hematuria, with a transfusion requirement exceeding 2 units 1
Review of anticoagulation/antiplatelet medications that may be contributing to bleeding is essential in the management of post-TURP hematuria 1

Strict bed rest and avoidance of straining are recommended for patients with post-TURP hematuria who can void without clots, with manual irrigation may be needed if clots obstruct the catheter 2
Continuous bladder irrigation (CBI) with normal saline should be initiated to prevent clot formation, with adjustment of CBI rate to maintain light pink or clear effluent 2

The AUA guidelines identify gross hematuria due to BPH as an indication for surgical intervention, and post-TURP bleeding requiring re-intervention represents a surgical complication that may necessitate repeat endoscopic evaluation or fulguration by a urologist 3, 4
Premature catheter removal should not be attempted until effluent is clear for 24 hours, to prevent complications 4
Failure to recognize the need for transfer to a facility with urologic capability can lead to poor outcomes, and small ERs without urology should have a low threshold for transfer when conservative measures fail 2, 5, 6
Arranging follow-up within 24-48 hours with urology or primary care is crucial for patients with post-TURP hematuria 3