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Tranexamic Acid Does Not Improve Outcomes of Holmium Laser Enucleation of the Prostate (HoLEP): A Prospective Randomized, Controlled Trial

Northwestern University Feinberg School of Medicine, 12244, Urology, Chicago, Illinois, United States. University of Calgary, 2129, Surgery, Section of Urology, Calgary, Alberta, Canada; markassmus@gmail.com. Northwestern University Feinberg School of Medicine, 12244, Urology, Chicago, Illinois, United States; matthew.s.lee11@gmail.com. Northwestern University Feinberg School of Medicine, 12244, Urology, Chicago, Illinois, United States; jessica.helon@northwestern.edu. Northwestern Medicine, 370076, Urology, Chicago, Illinois, United States; gecoots2@gmail.com.

Journal of endourology. 2022
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Abstract
INTRODUCTION Tranexamic acid (TXA) is a clot promoting agent utilized during orthopedic procedures to decrease bleeding. Urologists have demonstrated benefits of TXA in percutaneous surgery. Our objective was to assess safety and efficacy of single-dose TXA on same-day HoLEP outcomes. METHODS From September 2021 to January 2022, we prospectively randomized 110 patients undergoing HoLEP to either 1 gram of TXA after induction or no treatment. IRB approval (STU00215134) and registry with ClinicalTrials.gov (NCT05082142) was obtained prior to enrollment. Primary outcome was rate of successful same day discharge (SDD). Secondary outcomes included transfusion rate, same day catheter removal, length of stay (LOS), and 90-day complications. Power analysis determined 110 patients should be enrolled to detect a 25% difference in SDD rate. RESULTS There was no difference in patient demographic and prostate features between control (n=55) and TXA groups (n=55) (all p>0.05). The overall rate of successful SDD was not different between control and TXA groups (49/55 (89%) vs. 51/55 (93%), p=0.74). Median LOS (hh:mm) was not different between groups (03:07 vs. 02:50, p=0.23) with only 3/110 (2.7%) having a LOS >24hours. Successful same day catheter removal occurred in 99/110 (90%) patients with no difference between groups (49/55 vs. 50/55, p=0.99). There was no difference in operative parameters (time, energy, specimen weight) and postoperative complications between groups (all p>0.05). No patients required transfusions and there were no major 90-day complications related to surgery (Clavien-dindo ≥IIIb). CONCLUSION TXA administration is safe but did not impact same day discharge after HoLEP.
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Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine