The efficacy of tranexamic acid in decreasing bleeding during transurethral resection of prostate: A systematic review and meta-analysis

Purpose: Transurethral resection of the prostate (TURP) remains the standard surgical treatment for benign prostatic hyperplasia. Perioperative bleeding is a major concern and may lead to blood transfusion, prolonged catheterization, and extended hospital stay. Tranexamic acid (TXA), an antifibrinolytic agent, has been used to reduce surgical bleeding; however, its efficacy in TURP remains controversial. This systematic review and meta-analysis aimed to evaluate the effectiveness of TXA in reducing perioperative bleeding and improving operative outcomes in patients undergoing TURP. Materials and methods: A systematic search of multiple electronic databases was conducted to identify controlled trials comparing TXA with placebo or no intervention in patients undergoing TURP. Eligible studies were required to report hemoglobin change as the primary outcome. Data were pooled using mean differences (MD) with 95% confidence intervals (CI) were calculated. Results: Thirteen studies comprising 1127 participants met the inclusion criteria. Meta-analysis demonstrated a significantly smaller decline in hemoglobin levels in the TXA group compared with control (MD, −0.62; 95% CI, −0.93 to −0.32; P < .0001). TXA significantly reduced operative blood loss (MD, −104.35 mL; 95% CI, −163.35 to −45.41; P = .0005), shortened operative time (MD, −6.95 minutes, 95% CI, −11.62 to −2.27; P = .004), and decreased catheterization duration (MD, −0.18 days; 95% CI, −0.36 to −0.01; P = 0.04). Conclusion: TXA appears to significantly reduce perioperative bleeding and improve operative efficiency in patients undergoing TURP. Nevertheless, further large-scale, high-quality randomized controlled trials are warranted to confirm these findings and establish definitive clinical recommendations.