Intra-Prostatic Epinephrine injection in Bipolar Transurethral resection of large prostate: Exploring Its Role in Optimizing Surgical Outcomes

Abstract Background Benign prostatic hyperplasia (BPH) is a common condition in aging men, with transurethral resection of the prostate (TURP) remaining the gold standard surgical intervention. Perioperative bleeding represents one of the most significant complications, particularly in large prostates. Intraprostatic epinephrine injection has been proposed as a hemostatic adjunct. This study evaluates the efficacy of intraprostatic epinephrine injection during bipolar TURP in reducing blood loss and improving surgical outcomes. Methods In this single-center randomized controlled trial, 80 men with symptomatic BPH and prostate volumes of 80–100 mL were allocated equally to bipolar TURP with intraprostatic injection of either epinephrine (200 mcg in 20 mL saline) or saline alone. Patients with cardiovascular comorbidities were excluded. Perioperative blood loss (irrigation-fluid hemoglobin method), transfusion requirement, resection time, operative vision, complications, and follow-up functional outcomes were compared. Results Baseline characteristics were comparable between groups. Epinephrine reduced perioperative blood loss (median 87.5 vs 132.5 mL, p < 0.001) and eliminated blood transfusion (0% vs 12.5%, p = 0.021). Operative vision was rated excellent or good in 97.5% versus 85% (p = 0.048). Resection time was shorter (50.9 vs 77.6 minutes, p < 0.001) despite greater resected tissue weight (81.6 vs 71.4 g, p < 0.001), and postoperative hemoglobin decline was smaller (p < 0.001). Postoperative serum sodium and creatinine remained comparable between groups. Hospital stay was shorter with epinephrine (p = 0.004). Hypertension and arrhythmia occurred in 5% of epinephrine patients versus none of the controls (p = 0.494), other early complications were comparable. At follow-up, the epinephrine group showed a smaller residual prostate volume (7.6 vs 16.9 mL, p < 0.001) and a lower post-void residual volume (p = 0.015), with comparable symptom scores, flow rates, retrograde ejaculation, and re-operation rates. Conclusions Intraprostatic epinephrine during bipolar TURP significantly reduces bleeding and transfusion requirements, improves visualization, and enables faster, more complete resection without increasing cardiovascular risk. It is a simple, inexpensive, and readily available adjunct that merits routine use for large-volume prostates.