Efficacy and Safety of Tranexamic Acid in Endoscopic Surgery for Benign Prostatic Hyperplasia: A TURP-Dominated Systematic Review and Meta-Analysis.

Authors

Baining Zhang, Jingpeng Liu, Yong Zhang, Yumeng Chai

Published in

Archivos espanoles de urologia. Volume 79. Issue 8. Pages 1406-1418.

Abstract

Hemorrhaging continues to be a significant issue in endoscopic procedures for benign prostatic hyperplasia (BPH). Tranexamic acid (TXA) has garnered heightened scrutiny for its ability to mitigate bleeding-associated problems during transurethral prostate procedures. We performed a comprehensive meta-analysis to assess the effectiveness and safety of TXA in individuals having endoscopic procedures for BPH, acknowledging that the existing data primarily originated from transurethral resection of the prostate (TURP).
PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang, ClinicalTrials.gov, and ICTRP were examined from the beginning of their databases until April 2026. Pooled mean differences (MDs) and risk ratios (RRs) together with 95% confidence intervals (CIs) were computed utilizing RevMan 5.4. Sensitivity analyses and assessment of publication bias were performed using R version 4.4.2.
Fifteen randomized controlled studies with 1,310 people were qualified. Compared to the control group, TXA significantly reduced operational time (MD = -6.49 minutes, 95% CI: -10.79 to -2.20) and intraoperative blood loss (MD = -66.68 mL, 95% CI: -123.84 to -9.51). TXA also led to significantly less hemoglobin loss at 24 hours (MD = -0.58 g/dL, 95% CI: -0.88 to -0.29) and decreased irrigation fluid volume (MD = -0.45 L, 95% CI: -0.80 to -0.10). However, there were no significant differences between groups in duration of continuous bladder irrigation, catheterization time, length of stay, weight of resected adenoma, blood transfusion requirements, incidence of deep vein thrombosis (DVT) or quality of endoscopic.
TXA correlated with less intraoperative hemorrhage, decreased hemoglobin depletion after 24 hours, reduced irrigation fluid usage, and shortened surgical duration in endoscopic procedures for BPH. These results should be regarded primarily as evidence from TURP, demonstrating consistent effects across both monopolar and bipolar subgroups. Evidence outside TURP was limited to a single holmium laser enucleation of prostate RCT, which contributed data only to operative time among the statistically significant outcomes. Reported DVT were rare, and the available evidence remains underpowered to determine the thromboembolic safety profile of TXA. Additional RCTs are necessary to elucidate the function of TXA in various surgical methodologies and among patients with an elevated risk of hemorrhage. The PROSPERO Registration: The study was registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD420251044211; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251044211).

PMID:
42876131
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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