Is Group and Saving Before the Modern Bipolar Transurethral Resection of the Prostate Still Necessary?

Main Article Content

Leo Kretzmer
Adebiyi Damola
Chloe Libotte
Syed Ali Ehsanullah
Adam Jones
Ike Apakama

Abstract

Introduction: Group and save (G&S) sampling is commonplace for patients undergoing transurethral resection of the prostate (TURP) due to the historically high risk of bleeding. However, modern adjustments to the procedure, including the advent of bipolar TURP in saline, have significantly reduced this risk. This study assessed whether routinely performing G&Ss before the modern TURP is still appropriate. Materials and


Methods: This study was a retrospective review of all patients who underwent a TURP from January 2009 until December 2019 in one centre. A total of 687 patients were identified during this period. In addition, data was collected on G&S samples, blood products, and postoperative complications such as clot retention or if patients required a blood transfusion.


Results: All patients had G&S samples taken before their operation. Only six (0.87%) patients required a blood transfusion. Half were transfused intra-operatively and half post-operatively. Remarkably, none of the transfused patients were below the National Institute for Health and Care Excellence (NICE) threshold to transfuse of <70g/L(8). Six patients were also noted to develop clot retention following the catheter removal.


Discussion and Conclusion: This study has determined that patients undergoing a TURP rarely require blood transfusions. We propose that the practice of routinely taking G&S samples before this procedure should be reviewed. This would give a financial benefit and relieve patients of the unnecessary test. We would recommend thorough optimisation of patients before surgery, including review of anticoagulation and correction of any preoperative anaemia.

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How to Cite
Kretzmer, L., Damola, A., Libotte, C., Ehsanullah, S. A., Jones, A., & Apakama, I. (2022). Is Group and Saving Before the Modern Bipolar Transurethral Resection of the Prostate Still Necessary?. Journal of Endoluminal Endourology, 5(2), e44-e48. https://doi.org/10.22374/jeleu.v5i2.150
Section
Original Article
Author Biographies

Leo Kretzmer, Queen Elizabeth Hospital, Birmingham, England, United Kingdom

Queen Elizabeth Hospital, Birmingham, England, United Kingdom

Adebiyi Damola, University College London, United Kingdom

University College London, United Kingdom

Chloe Libotte, The George Eliot Hospital NHS Trust, Nuneaton, United Kingdom

The George Eliot Hospital NHS Trust, Nuneaton, United Kingdom

Syed Ali Ehsanullah, Warwick Medical School, University of Warwick, Coventry, United Kingdom

Warwick Medical School, University of Warwick, Coventry, United Kingdom

Adam Jones, The Royal Berkshire NHS Foundation Trust

The Royal Berkshire NHS Foundation Trust

Ike Apakama, Warwick Medical School, University of Warwick, Coventry, United Kingdom

Warwick Medical School, University of Warwick, Coventry, United Kingdom

References

1. Nice.org. The-TURis-system-for-transurethral-resection-of-the-prostate-f inal-scope2.pdf [Internet]. [cited 2020 May 23]. Available from: https://www.nice.org.uk/guidance/mtg23/documents/the-TURis-system-for-transurethral-resection-of-the-prostate-final-scope2
2. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP) – incidence, management, and prevention. Eur Urol. 2006 Nov;50(5):969–79; discussion 980. https://doi.org/10.1016/j.eururo.2005.12.042
3. Doll HA, Black NA, McPherson K, Flood AB, Williams GB, Smith JC. Mortality, morbidity and complications following transurethral resection of the prostate for benign prostatic hypertrophy. J Urol. 1992 Jun;147(6):1566–73. https://doi.org/10.1016/S0022-5347(17)37628-0
4. Zwergel U, Wullich B, Lindenmeir U, Rohde V, Zwergel T. Long-term results following transurethral resection of the prostate. Eur Urol. 1998;33(5): 476–80. https://doi.org/10.1159/000019638
5. Geavlete B, Georgescu D, Multescu R, Stanescu F, Jecu M, Geavlete P. Bipolar plasma vaporization vs monopolar and bipolar TURP-A prospective, randomized, long-term comparison. Urology. 2011 Oct;78(4):930–5. https://doi.org/10.1016/j.urology.2011.03.072
6. Chen Q, Zhang L, Liu YJ, Lu JD, Wang GM. Bipolar transurethral resection in saline system versus traditional monopolar resection system in treating large-volume benign prostatic hyper-plasia. Urol Int. 2009;83(1):55–9. https://doi.org/10.1159/000224869
7. Akman T, Binbay M, Tekinarslan E, Tepeler A, Akcay M, Ozgor F, et al. Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study. BJU Int. 2013 Jan;111(1):129–36. https://doi.org/10.1111/j.1464-410X.2012.11266.x
8. Nice.org. Recommendations | Blood transfusion | Guidance | NICE [Internet]. NICE; [cited 2021 Jan 17]. Available from: https://www.nice.org.uk/guidance/ng24/chapter/Recommendations#red-blood-cells-2
9. Batt J, Chambers, A, Mason J, Mullan M. Is group and save still a necessary test in the pre-operative workup for breast cancer surgery? J Periop Pract. 2021;31(5):187–190. https://doi.org/10.1177/1750458920925354
10. Hamza N, Pereira M, Gilliam A. Routine ‘group and save’ is unnecessary on the day of surgery of elective laparoscopic cholecystectomy. The Bulletin. 2015;97(6): E1–E4. https://doi.org/10.1308/147363515X14272809071167
11. Malik H, Bishop H, Winstanley J. Audit of blood transfusion in elective breast cancer surgery – do we need to group and save pre-operatively? Annals. 2008 Sept;90(6):472–473. https://doi.org/10.1308/003588408X301091
12. Smith H, Falconer R, Szczachor J, Sarfraz A. Routine preoperative group and save for TURP and TURBT - need and cost effectiveness. J Clin Urol. 2017 July;11(1):33–37. https://doi.org/10.1177/2051415817717908
13. Thomson P, Ross J, Mukherjee S, Mohammadi B. Are routine blood group and save samples needed for laparoscopic day case surgery? World J Surg. 2016;40:1295–1298. https://doi.org/10.1007/s00268-016-3463-8
14. Chouari T, Rangarajan K, Howe T, Osman H, Daoud R, Laidlaw I, Karat I. Blood group and save samples for elective breast surgery: an unnecessary cost?. Eur J Cancer 2020 Oct;138(1):S49–S50. https://doi.org/10.1016/S0959-8049(20)30656-0