Shigemura, K., Yasufuku, T., Yamanaka, K., Yamashita, M., Uefuji, T., Arakawa, S., & Fujisawa, M. (2010). Limited hydration may reduce intraoperative blood loss in retropubic radical prostatectomy. Kobe Journal of Medical Sciences, 56, E18–E23.

To investigate how limited hydration in the first part of retropubic radical prostatectomy (RRP) affects the volume of intra-operative total blood loss to offer a definite hydration method during RRP

The experimental group underwent a RRP performed by the same surgeon. Eight anesthesiologists took part in the study, with each anesthesiologist completing a single case. During the first two hours of the procedure, the amount of IV fluids the patient received was limited to 1,500 ml. The control group also had RRP performed by the same surgeon; however, there was no definite methods of hydration. The two groups were matched in regard to age, serum prostate-specific antigen score, specimen weight, body mass index, performance of neoadjuvant hormonal therapy, and total IV infusion volume. No patients in either group received nerve-sparing surgery. Measurements included blood loss, IV infusion volume in the first two hours of surgery, total infusion volume, and pre- and postoperative hematocrit value.

• N = 37
• AGE = 51–79 years
• MEDIAN AGE = 66.5 years
• MALES: 100%          
• KEY DISEASE CHARACTERISTICS: Both the control and experimental groups were diagnosed with prostate cancer with elevated PSA scores. Gleason’s ranged from 6–9, with 40% of patients receiving neoadjuvant hormonal therapy prior to surgery. 
• OTHER KEY SAMPLE CHARACTERISTICS: None

• SITE: Single site  
• SETTING TYPE: Inpatient  
• LOCATION: Akashi Municipal Hospital

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Elder care 

• Controlled trial

• Blood loss 
• IV infusion volume in the first two hours of surgery
• Total infusion volume 
• Pre- and postoperative hematocrit value

The study demonstrated that patients receiving limited hydration remained normotensive during the first two hours of their RRP (p = 0.0343). The experiment group, those receiving limited hydration, as compared to those without IV infusion limits, also demonstrated a significant difference in overall blood loss (p = -0.0301). However, the authors further concluded that patients receiving limited hydration did not experience any adverse effects from the limited hydration (i.e., dehydration). There was no evidence in the article to support this conclusion other than one blood pressure writing during the first two hours of surgery.

Use of limited hydration in RRP during the first two hours of surgery is shown to significantly reduce blood loss (p = 0.0301). However, further studies are needed to determine if limiting hydration causes any adverse effects from the effects of dehydration.

• Small sample (less than 100)
• Risk of bias (no blinding)
• Key sample group differences that could influence results
• Findings not generalizable
• Differences in physique and shape of pelvis between Japanese and American men limits generalizability to American population; different methodologies of hydration should be considered.

The fluid balance assessment was accurate. Nurses should educate patients on surgery and the amount of bleeding to expect with the role of hydration in reducing bleeding.