The Role of Intraprostatic Injection of Epinephrine in Reducing Perioperative Blood Loss during Transurethral Resection of the Prostate (TURP) in Patients with Benign Prostatic Hyperplasia (BPH): A Systematic Review & Meta-Analysis

Objective: This systematic review and meta-analysis aims to evaluate the effectiveness of intraprostatic epinephrine injections in reducing perioperative blood loss during TURP for BPH. Materials and Methods: A systematic review and meta-analysis were conducted by searching the PubMed, EBSCO, and Cochrane databases up to September 2024. Randomized controlled trials (RCTs) and observational studies involving the use of intraprostatic epinephrine during TURP were included. The primary outcome assessed was perioperative blood loss, while secondary outcomes included hemoglobin changes, resected tissue volume, and resection time. Data analysis was performed using Review Manager 5.4 software. Results: A total of 185 patients from three RCTs and one comparative retrospective study were included in the systematic review. Among these, 144 patients from the RCTs were included in the meta-analysis. Intraprostatic epinephrine was associated with a significant reduction in hemoglobin decline (mean difference [MD]: 0.52 g/dL, p = 0.0002) and shorter resection time (MD: -10.57 minutes, p = 0.01). However, no significant differences were observed in perioperative blood loss (MD: -96.58 mL, p = 0.36) or the volume of resected tissue (MD: 3.71 g, p = 0.46). Conclusion: Intraprostatic epinephrine injections during TURP effectively reduce hemoglobin loss and resection time, improving surgical efficiency. However, no significant effects were observed on total perioperative blood loss or tissue volume resected. Variability in surgical techniques and patient factors likely contributed to inconsistent outcomes, underscoring the need for standardized protocols in future research.