Correlação do grau de hematúria pós-cirurgia por obstrução prostática benigna, avaliado por uma nova escala de hematúria, com desfechos intra e perioperatórios

• Ano de defesa: 2018
• Autor(a) principal: Mota, Priscila Kuriki Vieira [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Hematuria; Visual solor scale; Transurethral resection of prostate; Prostatectomy; Hematúria; Escala visual de cores; Irrigação vesical; Ressecção transuretral da próstata; Prostatectomia
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7259891; https://repositorio.unifesp.br/handle/11600/52920

Objective: Hematuria is one of the most frequent postoperative complications for patients undergoing surgery for benign prostatic obstruction (BPO). In clinical practice the descriptions of hematuria vastly varies and are not precise enough to provide an aligned communication among healthcare professionals. The objective of this study was to develop and validate a novel hematuria grading scale under continuous bladder irrigation, the Irrigation Hematuria Scale (IHS), and to evaluate the association of the hematuria grade following BPO surgery with perioperative outcomes. Methods: A novel hematuria grading scale, the IHS, was developed and validated using Kappa coefficient. Patients undergoing surgery for BPO had their hematuria graded by the HIS one minute after the start of continuous bladder irrigation at the end of the surgery. Demographics and peri/postoperative clinical data were collected and the association of hematuria grade and clinical outcomes was evaluated. Results: IHS was validated with an almost perfect interobserver agreement. A total of 665 patients were included 81.1%, transurethral resection of the prostate (TURP) and 18.9% transvesical open prostatectomy (TOP). Due to the low number of IHS grade ≥ 3, for the analysis the scale was aggregated into three grades: 0, 1 and 2+. A higher chance of postoperative hematuria was observed in patients undergoing TOP compared to those undergoing TURP, in which prostate volume and duration of surgery were positively associated with a higher chance of hematuria. In patients undergoing TURP, a higher grade of IHS was associated with a higher volume of postoperative irrigation, while in those undergoing TOP with IHS grade 2+ had higher volume of postoperative irrigation compared to those with grade 0 and 1. A longer duration of bladder irrigation was observed in TURP and IHS grade 2+ compared to IHS grade 0 and 1, and TOP IHS grade 2+ vs grades 0 and 1 and IHS grade 1 vs grade 0. Longer duration of postoperative bladder catheterization was positively associated with higher IHS grades, for both surgical groups. Patients with IHS grade 2+ had longer hospital length of stay. Conclusion: The IHS was demonstrated to be a reproducible, reliable and useful tool for the prediction of perioperative outcomes. There was a positive association between IHS grade and volume of postoperative irrigation, duration of postoperative irrigation, duration of postoperative bladder catheterization and hospital length of stay.