The efficacy of tranexamic acid in reducing intraoperative bleeding during transurethral resection of the prostate for benign prostatic hyperplasia (BPH): a systematic review and meta-analysis of randomized controlled trials

Background Benign prostatic hyperplasia (BPH) is a common urinary system disease in elderly men, and transurethral resection of the prostate (TURP) is the gold standard for treating BPH. However, this surgery often leads to intraoperative and postoperative bleeding. Tranexamic acid (TXA) is an antifibrinolytic drug commonly used for hemostasis. This study aims to investigate the hemostatic effect of tranexamic acid in TURP surgery. Aim Evaluate the efficacy of tranexamic acid in TURP surgery. Methods We systematically searched the PubMed, Embase, EBSCO, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) on TXA treatment for bleeding during transurethral resection of the prostate (TURP), published up to December 2025. Data analysis and management were performed using Review Manager version 5.3. Result After applying the predefined inclusion and exclusion criteria, a total of eight studies involving 611 patients were included in our meta-analysis. The results of our analysis indicated that the TXA group significantly outperformed the control group in three outcomes: intraoperative blood loss ( P = 0.04), postoperative 24-hour hemoglobin levels ( P < 0.001), and postoperative 24-hour hemoglobin difference ( P = 0.02). However, no significant differences were observed between the TXA and control groups regarding surgical time ( P = 0.28) and length of hospital stay ( P = 0.08). Conclusions Compared to the control group, TXA significantly reduces intraoperative and postoperative bleeding in TURP surgery, making it valuable for anemic patients and in reducing surgical complications.