The Possibility of Forecast an Expressed Intraoperative Bleeding During Transurethral Resection of the Prostate using Preoperative Transrectal Ultrasound

There is no doubt about the prevalence rate of benign prostate  hyperplasia. Currently, transurethral prostate resection (TUR) is the  main method of surgical treatment. To clarify the degree of possible  intraoperative bleeding, we assume the application of pre-hospital  transrectal ultrasonic prostate examination (TRU) with vascular  Doppler and 2D Shear Wave elastography.

The aim: to evaluate the possibilities of preoperative complex TRU  prostate examination in forecasting of the expressed intraoperative bleeding.

Materials and methods. The study included the results of a survey of 242 patients in the urological Department of the road clinical hospital of Rostov-on-don in the period from 2016 to 2017, which  had undergone TUR of the prostate. All patients before the operation was performed prostate transrectal ultrasonography (TRU) with  Doppler and 2D Shear Wave Elastography (2DSWE). Depending on  the amount of blood loss determined after surgery, all patients were divided into three statistically (p < 0.001) significant groups (р  < 0.001). All TRU examinations were made with ultrasound system  Aixplorer (France). During Doppler sonography, maximal linear blood flow velocity (Vmax) in capsular arteries (CA), in “surgical capsule”  arteries (SCA) and in the paraurethral artery (PuA) was measured. During 2D Sheare Wave elastography (2D SWE) stiffness of tissues  was measured (in kPa) in symmetric areas of both lobes of  peripheral zone (PPZ), central zone (CZ), and transitory zone (TZ) of prostate

Results. Significant (p < 0.001) correlation of blood loss with  reduction of hemoglobin level, as well as with Vmax CA, Vmax PuA,  tissue stiffness TZ and areas on the border with the surgical capsule  revealed. The ROC analysis showed, that sensitivity and specificity of predictions of severe intraoperative blood loss, when using a cut-off  for the Vmax of the blood flow in CA more 18.7 cm/s, was  respectively 87.2% and 94.4 per cent; when using a cut-off for the  Vmax of the blood flow in the basin PUA over 24.2 cm/s –  respectively of 76.6% and 78.5%; when using a cut-off of stiffness  of the tissues TZ less of 39.8 kPa – respectively 100% and 95.4%: when using a cut-off of stiffness of the tissues at the border of the “surgical capsule” less than the 38.1 kPa – respectively 89,4% and 90,8%.

Conclusion. The use of cut-off Vmax values for the blood flow in the paraurethral and capsular arteries, as well as the use of cut-off  values for tissue stiffness in the prostate transitory zone of prostate  and in the surgical capsule area, may be an effective means of  forecasting of expressed intraoperative bleeding. The data presented is recommended to take into account the operating surgeon during  the selection of patients for operative benefits.

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