STUDIES ON THE MECHANISM OF BLEEDING DURING AND AFTER PROSTATECTOMY AND ITS PREVENTION

Abstract

The purpose of this paper is to determine how to minimize postoperative, hemorrhage in suprapubic prostatectomy. For this purpose studies were made on the anatomy of the prostatic arteries and prostatic fibrinolysis.
As a first step, anatomical studies of the prostatic arteries were made on 9 male cadavers. Nelaton's catheter was inserted through the aorta into the iliac artery and barium sulfate was injected through the catheter. After the injection the total pelvic organs were extirpated and the X-ray film was taken. Stereoradiography was also employed. As the results, two new facts were found.
1. There were as many arteries for the inward route of the prostatic arteries around the 2 and 10 o'clock of the bladder neck as beyond expectation.
2. The communications between the prostatic arteries and the middle rectal arteries are frequently found and direct hemostasis of the communicating vessels is almost impossible at surgery.
These anatomical facts rationalize the new procedures in suprapubic prostatectomy (mass ligation not only at 5, 7, 2 and 10 o'clock, but also around the bladder neck...Tsuchiya and Harada).
As a second step, studies of fibrinolytic activities were made on 45 patients with prostatic hypertrophy before, during and after the prostatectomy with special reference to the correlation between fibrinolytic activity and blood loss. Fibrinolytic activity was mainly measured by the fibrin-plate method. Hyperfibrinolytic activity was found in 41 per cent of the untreated prostatic cancer. However, in cases of prostatic hypertrophy the values were within normal limits. In the secretion from the prostatic tissue and prostatic bed, rather remarkable values were found. The fibrinolytic activity tends to show temporary enhancement during the prostatectomy and rather quick reversion to the normal level after the surgery. Some correlations were found between blood loss, fibrinolytic activity and the administered dosis of antifibrinolytic drug (Epsioln-aminocaproic acid) after the operation in 37 cases of suprapubic prostatectomy. The enhancement of fibrinolytic activity was found in 3 of 14 cases with uncontrollable hemorrhage from the prostatic bed after suprapubic prostatectomy. The enhancement of fibrinolytic activity was also found in 4 of 8 cases with gastrointestinal hemorrhage after prostatectomy.
Thus, the author is of the opinion that in some of the cases the severe hemorrhage from the prostatic bed and/or gastrointestinal tract after prostatectomy may be attributed to hyperfibrinolytic activity.