benign prostatic hyperplasia ( bph ) is a common condition affecting men older than 50 years of age .
the historical gold standard has been transurethral resection of prostate ( turp ) , which is an effective procedure but is still associated with risk of bleeding .
factors that influence perioperative and postoperative blood loss include : prostate weight , weight of the resected tissue , operating time , preoperative urine culture , preoperative finasteride treatment , use of acetylsalicylic acid , type of anesthesia , as well as patient age and blood pressure , although some of these associations remain controversial .
tranexamic acid ( txa ) is a potent inhibitor of plasminogen activators and urokinase , thereby preventing clot lysis , and has been shown to be 8-times more effective than epsilon aminocaproic acid ( eaca ) .
urine and urothelium contain high concentrations of plasminogen activators that facilitate the lysis of clots .
therefore , administration of antifibrinolytic agents might be beneficial in reducing the amount of postoperative blood loss resulting from turp .
txa is a synthetic antifibrinolytic drug that prevents the breakdown of fibrin , thereby stabilizing blood clots and reducing blood loss in conditions that promote fibrinolysis .
previous studies investigating the beneficial effects of these compounds on turp - associated bleeding have resulted in conflicting conclusions [ 6 , 7 ] .
recently , a growing body of evidence has indicated that txa is an effective agent for reducing blood loss in cardiac , orthopedic , and hepatic surgery .
txa has also been shown to be of benefit in the treatment of secondary hemorrhage associated with turp [ 8 , 9 ] . 
  in this report we investigated the effect of tranexamic acid on the amount of blood lost during tur - p .
its impact on operative time as well as duration of catheterization and hospitalization was also investigated .
a prospective and randomized trial was conducted with 40 men requiring turp for obstructive urinary symptoms .
the ethics committee of the hospital approved this study and the patients signed their consent on a written form of information .
exclusion criteria included a history or evidence of prostate disease other than bph , previous prostate surgery , treatment with any 5ari within 12- months , requirement for treatment with aspirin or nsaids during the restricted periods , and severe medical conditions such as liver disease , bleeding disorders ( e.g. hemophilia , von willebrand 's disease , etc . ) , and unstable cardiovascular problems .
all patients had both clinical and laboratory evidence of prostatic enlargement caused by benign prostatic hyperplasia .
the patients with even registry numbers were allocated to the treatment group , while those with odd numbers were used as controls and received no treatment .
the treatment group received 10 mg / kg txa by intravenous infusion during the first half hour of the operation .
patients taking acetylsalicylic acid or warfarin discontinued their treatment seven and two days before surgery , respectively .
the volume and hemoglobin concentration of the irrigation fluid , resected prostate weight , and duration of resection were recorded .
all turps were performed under spinal anesthesia and by the same surgeon . we used a 26f resectoscope and warm irrigating fluid .
surgical blood loss was determined by the amount of hemoglobin in the irrigating fluid using a photometer as described previously .
the loss of the hemoglobin per gram of resected tissue at operation time was calculated by dividing the total resected prostate tissue by total hemoglobin loss .
differences between groups were analyzed with the two - tailed two - sample t test , mann- whitney u test , or chi - square test , as needed .
data of 20 patients treated with txa and 20 control patients were available . in the txa given group , of whom the average age was 67 , median prostate weight measured by abdominal ultrasound
the average age of the control group was 65 and median prostate weight was 43 g ( 36.0 - 80.0 g ) .
no statistically significant difference of age and prostate weight were detected between groups ( table 1 ) . 
 
patient characteristics the mean serum hemoglobin loss on the first postoperative day in the txa group was found to be 0.71 g / dl and was 0.98 g / dl in the control group .
even if there was a difference in hemoglobin decrease between the two groups , it was not statistically significant ( p = 0.086 ) ( table 2 ) . according to the hemoglobin in irrigating fluid , the mean hemoglobin loss in the txa group was 16.18 g and it was 24.83 g in the control group .
the mean hemoglobin loss per gram of resected prostate tissue was 1.25 g in the txa group and 2.84 g in the control group . according to this , total hemoglobin loss in the irrigating fluid and hemoglobin loss per 1 gram of prostate tissue was lower in txa given patients than in the control group ( p = 0.018 and p < 0.001 ) ( table 2 ) . 
 
comparisons of treatment group and control group the total amount of irrigation fluid used , operation time , and the amount of resected prostate tissue were compared in txa and control groups .
average irrigation fluid used during tur - p was 16.34 l in txa and 20.05 l ( p = 0.027 ) in control groups .
the duration of operation was 46.75 minutes in the txa given and 63.5 minutes in the control group ( p < 0.001 ) .
the mean resected prostate tissue was found to be 24.33 g in the txa given group and 16.68 g in the control group ( p < 0.038 ) .
the duration of catheterization and hospitalization are the same in both groups ( p = 0.415 , p = 0.218 ) ( table 2 ) . according to multiple regression analyses ,
the irrigation fluid was less and operation time was shorter ( p = 0.027 , p < 0.001 ) ; resected prostate tissue was statistically more ( p = 0.038 ) in the txa group than the control group . however txa treatment had no effect on the duration of catheterization and hospitalization .
turp is the standard method for relieving bladder outlet obstruction in men with bph , but the operation still requires in - hospital management due to a relatively high incidence of complications during and afterward , particularly in patients with large prostates . in one study ,
perioperative blood loss was > 1 l in 13% of the patients , leading an increased the risk of hemodynamic instability and the need for erythrocyte transfusions .
hematuria and clot retention after turp might prolong the hospital time and may even necessitate re - operation . to reduce the perioperative and postoperative bleeding ,
several different approaches have been tried , including intravenous administration of estrogens , catheter traction , intraprostatic vasopressin , per os etamsylate , fibrin adhesive , phenol solution , and , more recently , finasteride [ 11 , 12 , 13 ] .
although these approaches have yielded some promising results , no one technique has gained widespread acceptance and incorporation into surgical routine .
treatment with finasteride or other antiandrogens before turp was reported to reduce surgical blood loss , but not all studies showed a consistent effect .
finasteride is thought to act by mediating androgen - dependent growth factors that regulate angiogenesis in the prostate .
txa , in contrast , accumulates in the extracellular space of tissues where it inhibits tissue fibrinolysis [ 12 , 14 ] .
postoperative turp - associated blood loss has been correlated with an increase in urinary fibrinolytic activity .
there have been studies related to txa usage before turp [ 8 , 9 ] . in these studies ,
we used txa treatment by intravenous infusion during the first half hour of the operation . during turp
, similar results were obtained according to total hemoglobin decrease in the studies of oral txa use .
in addition to reduced operative blood loss , we were surprised to observe a statistically significant decrease in the operative time and volume of irrigating fluid required
. reduced bleeding during turp as a result of txa treatment may lead to better surgical conditions and , as a consequence , shorter operative times and lower irrigating fluid volumes .
this is an intriguing finding , because absorption of irrigating fluid is another concern with turp and is associated with increased operative time and blood loss .
none of our 40 patients had clinical signs of irrigating fluid absorption [ transurethral resection syndrome ] .
the frequency of transurethral resection syndrome varied from 0.18% to 10.9% ; therefore , we would have had a much larger pool of patients to detect any statistically significant differences .
several studies have demonstrated that txa treatment does not predispose a patient to thromboembolic complications [ 16 , 17 ] .
txa treatment reduced operative blood loss and decreased the operative time and volume of irrigating fluid required .
reduced bleeding during turp as a result of txa treatment could lead to better surgical conditions and , as a consequence , shorter operative times and lower irrigating fluid volumes .
 introductionpostoperative blood loss after prostate surgery is thought to be associated with an increase in urinary fibrinolytic activity . 
 tranexamic acid ( txa ) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously . 
 we investigated the effect of txa on the amount of blood loss during transurethral resection of the prostate ( turp).materials and methodsforty patients with registry numbers ending in even numbers were allocated to the treatment group ; those ending in odd numbers were used as controls and received no treatment . 
 the treatment group received 10 mg / kg txa by intravenous infusion during the first half hour of the operation , while the control group of patients received no medication . 
 serum hemoglobin was measured before and after surgery . 
 the volume and hemoglobin concentration of the irrigation fluid , resected prostate weight , and duration of resection were recorded.resultsthe mean loss of hemoglobin per gram of resected prostate tissue was 1.25 g in the txa group and 2.84 g in the control group . 
 total hemoglobin loss in the irrigating fluid and hemoglobin loss per 1 gram of prostate tissue was lower in the group of patients given txa than in the control group ( p = 0.018 and p < 0.001).conclusionreduced bleeding during turp as a result of txa treatment may lead to better surgical conditions and , as a consequence , shorter operative times and lower irrigating fluid volumes . 
INTRODUCTION
MATERIAL AND METHODS
RESULTS
DICUSSION
CONCLUSION