Publication:

Role of topical tranexamic acid in reducing post-TURP hematuria: a randomized controlled study

Background Postoperative hematuria is a common and clinically significant complication following transurethral resection of the prostate (TURP). Tranexamic acid (TXA), an antifibrinolytic agent, has been investigated to reduce perioperative bleeding in various surgical settings. This study aimed to evaluate the efficacy and safety of topical TXA added to irrigating fluid during monopolar TURP in reducing postoperative hematuria and related outcomes.

Methods This prospective randomized controlled study was conducted at Dinajpur Medical College Hospital from July 2024 to December 2025. 50 men undergoing monopolar TURP for benign prostatic hyperplasia (BPH) were randomly assigned (1:1) into two groups. The TXA group received 1.5% glycine irrigation with 500 mg/l topical TXA, while the control group received standard 1.5% glycine irrigation. Primary outcomes included duration of gross hematuria and postoperative hemoglobin drop. Secondary outcomes were clot retention, duration of bladder irrigation, catheterization, hospital stay and blood transfusion rate. Data were analyzed using SPSS version 26.

Results The TXA group demonstrated a significantly shorter duration of gross hematuria (18.6±6.3 vs. 31.4±8.2 hours; p<0.001) and a smaller postoperative hemoglobin reduction (0.9±0.4 vs. 1.6±0.6 g/dl; p<0.001). Fewer patients required bladder irrigation beyond 24 hours (12.0% vs. 36.0%; p=0.04). Differences in clot retention (8.0% vs. 28.0%; p=0.07) and blood transfusion rates (4.0% vs. 16.0%; p=0.16) were not statistically significant.

Conclusions Topical TXA in irrigating fluid during TURP effectively reduces postoperative hematuria and hemoglobin loss without significant adverse effects, making it a safe and cost-effective adjunct in BPH surgery.