Absorption of Irrigation Fluid Occurs Frequently during High Power 532 nm Laser Vaporization of the Prostate

Abstract

Purpose Absorption of irrigation fluid was not detected during GreenLight™ laser vaporization of the prostate using the first generation 80 W laser. However, data are lacking on intraoperative irrigation fluid absorption using the second generation 120 W high power laser. We assessed whether fluid absorption occurs during high power laser vaporization of the prostate. Materials and Methods We performed this prospective investigation at a tertiary referral center in patients undergoing 120 W laser vaporization for prostatic bladder outlet obstruction. Normal saline containing 1% ethanol was used for intraoperative irrigation. The expired breath ethanol concentration was measured periodically during the operation using an alcometer. The volume of saline absorption was calculated from these concentrations. Intraoperative changes in hematological and biochemical blood parameters were also recorded. Results Of 50 investigated patients 22 (44%) had a positive breath ethanol test. Median absorption volume in the absorber group was 725 ml (range 138 to 3,452). Ten patients absorbed more than 1,000 ml. Absorbers had a smaller prostate, more capsular perforation, higher bleeding intensity and more laser energy applied during the operation. Three patients (13%) had symptoms potentially related to fluid absorption. Hemoglobin, hematocrit and serum chloride were the only blood parameters that changed significantly in the absorber group. The changes were significantly different than those in nonabsorbers. Conclusions Fluid absorption occurs frequently during high power laser vaporization of the prostate. This should be considered in patients who present with cardiopulmonary or neurological symptoms during or after the procedure. The purpose of this investigation was to assess whether fluid absorption occurs during highpower LV of the prostate. Materials and Methods:This prospective investigation was conducted in a tertiary referral center with patients undergoing 120W LV for prostatic bladder outlet obstruction. Normal saline containing 1% ethanol was used for intraoperative irrigation. Expired breath-ethanol concentrations were measured periodically during the operation using an alcometer. The volume of saline absorption was calculated from these concentrations. Intraoperative changes in hematological and biochemical blood parameters were also recorded. Results:Of 50 investigated patients, 22 (44%) had a positive breath-ethanol test. The median absorption volume in the absorber group was 725ml (range: 138-3452ml). Ten patients absorbed more than 1000ml. Absorbers had smaller prostates, more capsular perforations, a higher bleeding intensity, and more laser energy was applied during their operations. Three patients (13%) had symptoms potentially related to fluid absorption. Hemoglobin, hematocrit and serum chloride were the only blood parameters, which changed significantly in the absorber group and showed a significantly different change in the group of absorbers compared to non-absorbers. Conclusions:Fluid absorpt...

Absorption of irrigation fluid during XPS™ GreenLight laser vaporization of the prostate: results from a prospective breath ethanol monitoring study

“…During LV using the first-generation low power 80W laser, fluid absorption was not detectable at all [21]. With the increased power output of the second-generation 120W laser, fluid absorption became detectable [20]. The results of the present study indicate that with the latest-generation high output power 180W laser absorption of high volumes became even more prevalent.…”

“…Significant differences between the two groups were detectable for hemoglobin, hematocrit, sodium, chloride, bicarbonate and venous pH. Despite the improved coagulation properties of the 180W laser the frequency of fluid absorption was comparable to the frequency observed during 120W LV [20]. It has previously been shown that low-pressure irrigation does not prevent but reduces fluid absorption during transurethral surgery of the prostate [24,25].…”

“…It has previously been shown that low-pressure irrigation does not prevent but reduces fluid absorption during transurethral surgery of the prostate [24,25]. Thus, it remains unclear if the higher median and maximum absorption volumes during 180W LV (950 ml and 4579ml, respectively) compared to those reported after 120W LV (725ml and 3452ml, respectively) are due to the different properties of the two lasers or to the different types of irrigation used in the two studies [20]. During LV using the first-generation low power 80W laser, fluid absorption was not detectable at all [21].…”

1084 Is absorption of irrigation fluid a problem in thulium laser vaporization of the prostate? A prospective investigation using the expired breath ethanol test

“…Statistics, study sample size and power calculation Among those, median fluid absorption was 1249 ml (138 -2452 ml) [13]. This would indicate a mean fluid absorption of approximately 1250 ml, with standard deviation 579 ml.…”

“…The authors concluded, that these techniques should be used with caution in patients with significant cardiovascular comorbidities [12,13].…”