Urologic surgery in hemophiliac patients

Abstract

Hemophilia is an extremely interesting pathology for urologists, given the frequent involvement of the urogenital apparatus in these patients (hematuria and spontaneous hematomas - especially retroperitoneal, pathologies caused by clots in the urinary tract, etc.). From 1976 to 1995 we treated 17 patients: 15 (12 hemophiliac A and 3 B) for major and minor urological pathologies (3 prostatic hyperplasias of which 1 with bladder lithiasis, 1 adrenal adenoma, 1 nephrectomy for post-pyelolithotomy urinous fistula, 3 ureteral stones, 1 pyelic stone, 5 phimoses, 1 hydrocele) and 2 (hemophiliac A) with ESWL. 16 patients had no post-operative complications nor problems during follow-up (mean 86 months). 1 patient died the fourth day after nephrectomy due to septic shock and uncontrollable hemorrhage. The purpose of therapy in all the operated patients was to raise the level of factor VIII and IX to over 60% of the normal value and to keep it above 30% during the post-operative period until full surgical recovery. Only close team-work with hematologists and transfusionists, with at least temporary correction of hemostatic parameters plus special measures, will permit major surgery to be performed.