Computer‐controlled monitoring of bladder pressure in the prevention of ‘TUR syndrome’: a randomized study of 53 cases

J, Hubert; Cormier, Laurent; Gerbaud, Pascale; Guillemin, F; Pertek, J.P.; Mangin, P

doi:10.1046/j.1464-410x.1996.09815.x

Cited by 15 publications

(5 citation statements)

References 6 publications

(6 reference statements)

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“…Thus intravesical pressure is probably the pre‐eminent factor determining fluid absorption. This contention is supported by the good results of TURP using computer‐controlled monitoring of bladder pressure [ 19]. Continuous intravesical pressure monitoring during TURP in the present study showed clear differences, despite the continuous removal of fluid, suggesting that the Iglesias technique cannot be defined as a ‘low pressure’ TURP.…”

Section: Discussionsupporting

confidence: 62%

Frequency and causes of fluid absorption: a comparison of three techniques for resection of the prostate under continuous pressure monitoring

Heidler

1999

BJU International

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The three techniques for draining irrigation fluid produced significant differences in 'increased' intravesical pressure. In general, the levels of plasma sodium were not significantly different among the three techniques but patients with lower plasma sodium levels tended to have an increased intravesical pressure. In these cases, fluid absorption seems to be avoidable by an appropriate drainage technique. Nevertheless, considerable fluid absorption can occur at pressures of <20 cmH2O.

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Section: Discussionsupporting

confidence: 62%

Frequency and causes of fluid absorption: a comparison of three techniques for resection of the prostate under continuous pressure monitoring

Heidler

1999

BJU International

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“…Several authors have found irrigation using the suprapubic trocar to be efficient, 65 while others have not. There is even more widespread scepticism about the effectiveness of the Iglesias method.…”

Section: Low-pressure Irrigationmentioning

confidence: 99%

Fluid absorption in endoscopic surgery

Hahn

2006

British Journal of Anaesthesia

201

144

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Fluid absorption is an unpredictable complication of endoscopic surgery. Absorption of small amounts of fluid (1-2 litre) occurs in 5-10% of patients undergoing transurethral prostatic resection and results in an easily overlooked mild transurethral resection (TUR) syndrome. Large-scale fluid absorption is rare but leads to symptoms severe enough to require intensive care. Pathophysiological mechanisms consist of pharmacological effects of the irrigant solutes, the volume effect of the irrigant water, dilutional hyponatraemia and brain oedema. Other less widely known factors include absolute losses of sodium by urinary excretion and morphological changes in the heart muscle, both of which promote a hypokinetic circulation. Studies in animals, volunteers and patients show that irrigation with glycine solution should be avoided. Preventive measures, such as low-pressure irrigation, might reduce the extent of fluid absorption but does not eliminate this complication. Monitoring the extent of absorption during surgery allows control of the fluid balance in the individual patient, but such monitoring is not used widely. However, the anaesthetist must be aware of the symptoms and be able to diagnose this complication. Treatment should be based on administration of hypertonic saline rather than on diuretics. New techniques, such as bipolar resectoscopes and vaporizing instead of resecting tissue, result in a continuous change of the prerequisites for fluid absorption and its consequences.

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“…A pressure warning device may remind the surgeon to empty the bladder in time or to control the system in cases where continuous irrigation is used. However, the height of the fluid bag over the bladder is of no consequence as long as only a volume corresponding to the almost horizontal first phase of the bladder pressure curve is used [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…The resection is then resumed with more frequent emptying of the bladder to keep the pressure in the operating field below the assumed pressure in the veins (in case of IVA). The amount of bladder capacity that may be used is basically determined by the bladder compliance [8,9]. Just before the flow in the irrigating jet is beginning to decline (as a sign of rising pressure) the bladder is usually emptied.…”

Section: Methodsmentioning

confidence: 99%

How to master absorption during transurethral resection of the prostate: basic measures guided by the ethanol method

Hultén¹

2002

BJU International

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Objective To evaluate the effect of basic measures to minimize the absorption of irrigating fluid during transurethral resection of the prostate (TURP) to the planned end-point, using the ethanol method to guide the surgeon. Patients and methods Forty-six patients underwent TURP with intermittent irrigation using sterile water and 2% ethanol. The ethanol content in the expired breath of the patients was assessed every 5 min using a breath-alcohol monitor. In 25 patients no absorption was indicated but 21 showed some absorption according to the ethanol analyses. The operator was then immediately alerted, paused briefly to determine the route of absorption and to take advantage of blood clots to seal off leakage sites. On resuming the resection, attention was given to the pressure gradients in the operating field, based on bladder compliance and the flow in the irrigating jet. Repeated ethanol analyses were used to assess the result and to guide the surgeon's efforts. Results No operation had to be terminated prematurely; the mean absorption in the 21 patients in whom any ethanol was detected was 121 (75-230) mL. In 14 patients absorption occurred once, in six twice and in one there were three small absorption events. The group with absorption did not differ significantly from that with no absorption in operative duration (mean 48 and 47 min), resected weight (mean 32.8 and 31.6 g) or blood loss (mean 550 and 483 mL). Conclusions If the surgeon is alerted at the first positive ethanol reading, effective measures to minimize absorption can be taken early. Regular use of the ethanol method as an alarm system should permit TURP with a minimum of absorption and avoid an early interruption or premature termination of surgery because of absorption.

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Computer‐controlled monitoring of bladder pressure in the prevention of ‘TUR syndrome’: a randomized study of 53 cases

Abstract: The continuous computerized monitoring of bladder pressure during TURP effectively reduced the absorption of irrigant fluid, making the procedure safer for the patient and easier for the surgeon.

Cited by 15 publications

References 6 publications

Frequency and causes of fluid absorption: a comparison of three techniques for resection of the prostate under continuous pressure monitoring

Frequency and causes of fluid absorption: a comparison of three techniques for resection of the prostate under continuous pressure monitoring

Fluid absorption in endoscopic surgery

How to master absorption during transurethral resection of the prostate: basic measures guided by the ethanol method

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