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

Heidler,

doi:10.1046/j.1464-410x.1999.00969.x

Cited by 36 publications

(16 citation statements)

References 19 publications

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“…It has previously been shown that low-pressure irrigation does not prevent but decreases the amount of fluid absorption during transurethral surgery. 11,23,24 Furthermore, the operations were expeditiously terminated if a critical absorption volume was measured during ethanol monitoring. Thus, it is likely that in the absence of low-pressure irrigation and ethanol monitoring higher volumes of fluid absorption and potentially a higher rate of clinical symptoms would have been detectable.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2015

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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...

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Section: Resultsmentioning

confidence: 99%

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

et al. 2015

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“…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]. 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].…”

Section: Resultsmentioning

confidence: 79%

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

et al. 2016

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PURPOSE: To assess whether and to what extent irrigation fluid absorption occurs during laser vaporization (LV) of the prostate using the 180 W XPS™ GreenLight laser. METHODS: This prospective investigation was performed in a tertiary care center with a consecutive series of patients undergoing 180 W LV of the prostate. Intraoperative irrigation was performed with isotonic saline containing 1 % ethanol. The volume of irrigation fluid absorption was calculated from periodically performed breath ethanol measurements during LV. Additionally, intraoperative changes in biochemical and hematological blood parameters were assessed. RESULTS: Positive breath ethanol tests were detectable in 22 of 54 patients. The median absorption volume in these patients was 950 ml (range 208-4579 ml). Ten patients absorbed more than 2000 ml. Absorbers had smaller prostates, more capsular perforations and injuries to venous sinuses, and more total energy was applied with higher output power. Five patients had transient symptoms potentially related to fluid absorption. A significant drop in hemoglobin, hematocrit, venous pH and bicarbonate and an increase in chloride were detectable in the absorber group. These changes were significantly different in the non-absorber group. CONCLUSIONS: Absorption of irrigation fluid did occur in a relevant proportion of patients undergoing XPS™ GreenLight LV. High-volume absorption (2000 ml), which might be clinically relevant, was detectable in almost 20 % of all procedures. Absorption of saline irrigation fluid does not result in a classical TUR syndrome, but fluid and chloride overload can lead to serious complications, particularly in cardiovascular high-risk patients. Thus, patients with symptoms potentially related to fluid absorption should be monitored carefully.

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“…The clinical features are related with the severity of hyponatremia. This is a rare complication but a serious one [8]. The prevention hallmarks are carefully surgical practice and minimizing the resection time.…”

Section: Discussionmentioning

confidence: 99%

Complications of Transurethral Resection of the Prostate

Pesha¹

2016

CMR

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Abstract:Benign prostatic hypertrophy can be treated by several therapeutic options including medical and surgical techniques. Among the surgical options, transurethral resection has a crucial role. Transurethral resection of the prostate (TURP) remains the standard surgical treatment for benign prostatic hypertrophy (BPH). This technique was the first minimally invasive procedure of the modern surgical practice remaining the most commonly procedure. During 2010-2015, 324 patients were enrolled in our study, recording all postoperative complications. Our paper emphasizes all the theoretical aspects of TURP's complications comparing to our data.

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

Cited by 36 publications

References 19 publications

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

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

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

Complications of Transurethral Resection of the Prostate

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