Bleeding after endoscopic procedures

Definition

Bleeding is the most common complication after TURP, transurethral resection of the prostate, lithotripsy, and biopsy.

Types:

• Early (intraoperative or within the first few hours).
• Delayed (after 1–3 weeks).

Clinical assessment

• Gross hematuria with clots.
• Clot retention.
• Falling hemoglobin, hypotension, tachycardia.

Diagnosis

• Assess hemodynamics and Hb.
• Bladder ultrasonography for clots.
• Coagulation profile if coagulopathy is suspected.

Emergency management

• Large-bore three-way catheter + irrigation.
• If unsuccessful, perform cystoscopy + hemostasis.
• In massive bleeding, activate the approved major hemorrhage and transfusion protocol; involve an anesthesiologist/intensivist and the transfusion service. Document indications, patient and blood component identification, compatibility, timing, monitoring, and reactions.
• In delayed bleeding, rule out infection and adjust anticoagulant therapy.

Algorithm