Perioperative tranexamic acid and postoperative haematuria after transvesical prostatectomy: a prospective observational cohort study
4 affiliations
- 1Center for Anesthesiology and Reanimation, University Clinical Center of Serbia, Pasterova 2, Belgrade, 11000 Serbia
- 2Clinic for Urology, University Clinical Center of Serbia, Belgrade, Serbia
- 3Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- 4Institute for Medical Statistics and Informatics, Belgrade, Serbia
Abstract
Background: Bleeding and postoperative haematuria remain clinically relevant after open simple prostatectomy. Tranexamic acid (TXA) may reduce bleeding through antifibrinolytic activity, but evidence in open prostate surgery for benign prostatic obstruction is limited. This study evaluated perioperative bleeding-related outcomes and observed thromboembolic events associated with TXA exposure in patients undergoing transvesical prostatectomy.
Methods: This prospective, non-randomised, comparative cohort study included 72 patients undergoing transvesical prostatectomy between August 2020 and December 2021. Thirty-one patients received perioperative intravenous TXA and 41 were managed without TXA. Outcomes included intraoperative blood loss, postoperative drain output, quantified perioperative blood loss, blood product transfusion, postoperative haematuria requiring continued or re-initiated bladder irrigation, and clinically apparent thromboembolic events within 30 days. Logistic regression and quantile median regression were used for exploratory adjusted analyses.
Results: TXA exposure was not associated with statistically significant reductions in intraoperative blood loss, postoperative drain output, quantified perioperative blood loss, or blood product transfusion. Postoperative haematuria grade ≥ 1 occurred less frequently in the TXA group than in controls in unadjusted analysis (38.7% vs. 63.4%; p = 0.038). However, this association was attenuated and was no longer statistically significant after adjustment for prostate specimen weight, operative time, pre-existing urinary catheter status, and 5-alpha-reductase inhibitor therapy (adjusted OR 0.482, 95% CI 0.163–1.420; p = 0.186). Longer operative time remained associated with postoperative haematuria (adjusted OR 1.030 per minute, 95% CI 1.006–1.054; p = 0.013). Prostate specimen weight remained associated with blood product transfusion after adjustment. No clinically apparent thromboembolic events were recorded during hospitalisation or within 30 days postoperatively.
Conclusions: TXA exposure was associated with lower observed postoperative haematuria in unadjusted analysis, but this association did not persist after adjustment. TXA was not associated with significant reductions in quantified perioperative blood loss or blood product transfusion. These findings are exploratory and require confirmation in adequately powered randomised studies.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12894-026-02293-0.
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BibTeX
@article{terzic2026perioperative,
title = {{Perioperative tranexamic acid and postoperative haematuria after transvesical prostatectomy: a prospective observational cohort study}},
author = {Branka Terzić and Bogomir Milojević and Marko Živković and Vesna Jovanović and Nataša Petrović and Nikola Lađević and Uroš Bumbaširević and Miodrag Aćimović and Nebojša Lađević and Zoran Bukumirić},
journal = {BMC Urology},
year = {2026},
month = jul,
doi = {10.1186/s12894-026-02293-0},
url = {https://doi.org/10.1186/s12894-026-02293-0},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Perioperative tranexamic acid and postoperative haematuria after transvesical prostatectomy: a prospective observational cohort study
AU - Branka Terzić
AU - Bogomir Milojević
AU - Marko Živković
AU - Vesna Jovanović
AU - Nataša Petrović
AU - Nikola Lađević
AU - Uroš Bumbaširević
AU - Miodrag Aćimović
AU - Nebojša Lađević
AU - Zoran Bukumirić
PY - 2026
DA - 2026/07/31
JO - BMC Urology
DO - 10.1186/s12894-026-02293-0
UR - https://doi.org/10.1186/s12894-026-02293-0
AB - Background: Bleeding and postoperative haematuria remain clinically relevant after open simple prostatectomy. Tranexamic acid (TXA) may reduce bleeding through antifibrinolytic activity, but evidence in open prostate surgery for benign prostatic obstruction is limited. This study evaluated perioperative bleeding-related outcomes and observed thromboembolic events associated with TXA exposure in patients undergoing transvesical prostatectomy. Methods: This prospective, non-randomised, comparative cohort study included 72 patients undergoing transvesical prostatectomy between August 2020 and December 2021. Thirty-one patients received perioperative intravenous TXA and 41 were managed without TXA. Outcomes included intraoperative blood loss, postoperative drain output, quantified perioperative blood loss, blood product transfusion, postoperative haematuria requiring continued or re-initiated bladder irrigation, and clinically apparent thromboembolic events within 30 days. Logistic regression and quantile median regression were used for exploratory adjusted analyses. Results: TXA exposure was not associated with statistically significant reductions in intraoperative blood loss, postoperative drain output, quantified perioperative blood loss, or blood product transfusion. Postoperative haematuria grade ≥ 1 occurred less frequently in the TXA group than in controls in unadjusted analysis (38.7% vs. 63.4%; p = 0.038). However, this association was attenuated and was no longer statistically significant after adjustment for prostate specimen weight, operative time, pre-existing urinary catheter status, and 5-alpha-reductase inhibitor therapy (adjusted OR 0.482, 95% CI 0.163–1.420; p = 0.186). Longer operative time remained associated with postoperative haematuria (adjusted OR 1.030 per minute, 95% CI 1.006–1.054; p = 0.013). Prostate specimen weight remained associated with blood product transfusion after adjustment. No clinically apparent thromboembolic events were recorded during hospitalisation or within 30 days postoperatively. Conclusions: TXA exposure was associated with lower observed postoperative haematuria in unadjusted analysis, but this association did not persist after adjustment. TXA was not associated with significant reductions in quantified perioperative blood loss or blood product transfusion. These findings are exploratory and require confirmation in adequately powered randomised studies. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12894-026-02293-0.
SN - 1471-2490
ER -