Monitoring of fluid absorption with nitrous oxide during transurethral resection of the prostate

Drobin, Dan; Hjelmqvist, Hans; Piros, David; Hahn, Robert G.

doi:10.1111/j.1399-6576.2007.01572.x

Cited by 10 publications

(6 citation statements)

References 19 publications

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“…The intravascular absorption of irrigation fluid during TURP has been shown to be approximately 700 ml. [9] However, studies have demonstrated no significant intravascular absorption of irrigation fluid with PVP. [10–12] Thus for men with significant cardiovascular morbidity, in whom an increase in intravascular volume could precipitate cardiac failure, PVP potentially represents a safer option to conventional TURP.…”

Section: Discussionmentioning

confidence: 99%

Photoselective vaporization of the prostate in men taking clopidogrel

Spernat¹,

Hossack²,

Woo³

2011

Urol Ann

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Aim:To evaluate the peri-operative morbidity of men taking clopidogrel who underwent photoselective vaporisation of the prostate (PVP).Patients and Methods:A prospective database was collected. Between March 2005 and July 2010, 480 men underwent PVP. Of these, 18 men underwent PVP treatment while on clopidogrel. The surgery was carried out with either an 80W KTP laser or a 120W lithium triborate laser.Results:In the peri-operative period there were no complications related to PVP. There were no urinary tract infections, nor did any patient require bladder re-catheterisation. No cardiovascular events were reported within 3 months of the procedure. At 3 months post operatively, the International Prostate Symptom Score±standard deviation had improved from was 17.5±10.6 to 9.2±6.1 P<0.05. While the Quality of Life±standard deviation improved from 4.7±1.2 to 2.2±1.5 P<0.01. The maximum flow rate (Qmax), and post void residual volume (PVR) improved from 6.2±3.0 mL/s to 19.7±9.1 mL/s (P<0.01), and 140±102 mL to 59±77 mL (P<0.05), respectively.Conclusions:PVP is a safe and efficacious in the treatment of high risk patients with bladder outlet obstruction. Further, the ability to continue therapeutic anticoagulation and anti-platelet agents, is a significant advantage over Holmium enucleation of the prostate and conventional transurethral resection of the prostate. Larger studies with greater numbers of patients are required prior to PVP becoming the gold standard for high-risk patients with bladder outlet obstruction.

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Section: Discussionmentioning

confidence: 99%

Photoselective vaporization of the prostate in men taking clopidogrel

Spernat¹,

Hossack²,

Woo³

2011

Urol Ann

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“…Whenever glycine or ethanol is recognized as potentially toxic in the setting of TURP, alternative irrigants should be used. Some authors have suggested the use of expectedly safer irrigation fluids, such as glucose solution [1] or the use of tracers different from ethanol, such as nitrous oxide [17]. In the mean time, surgeons should be made aware that severe complications of TUR syndrome, such as acute liver failure, may occur.…”

Section: Discussionmentioning

confidence: 99%

Transient acute liver failure complicating transurethral resection syndrome

Tuccori

Guidi²,

Montagnani

et al. 2010

Scandinavian Journal of Urology and Nephrology

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Transurethral resection (TUR) syndrome, resulting from dilutional hyponatraemia for excessive absorption of irrigating fluid, represents the most relevant complication of transurethral resection of prostate (TURP). Ethanol is used as a tracer in the irrigant solution to monitor fluid absorption with a breathalyser. An unusual case of transient acute liver failure complicating TUR syndrome is reported. A 54-year-old male patient, without risk factors for the development of toxic hepatitis, was subjected to TURP for treatment of benign prostatic hyperplasia. Fluid absorption (2275 ml), estimated by breathalyser, exceeded maximum allowed absorption (2000 ml) only at the end of the surgical intervention. No signs of possible toxicity were evident in the few hours following the intervention. About 10 h after the end of TURP, the patient developed sweating, vomiting and diarrhoea. Laboratory analysis revealed severe hyponatraemia (116 meq/l) with signs of severe liver impairment (total bilirubin 5.8 mg/dl, alanine aminotransferase 56,500 U/l, aspartate aminotransferase 32,700 U/l), kidney failure (serum creatinine 1.93 mg/dl) and serum ethanol levels of 219 mg/dl (0.2%). The patient was treated with acetylcysteine 150 mg/kg i.v. and furosemide 50 mg i.v. Liver and renal functions improved in few days and recovered completely within 30 days. The TUR syndrome observed in this case was probably extravascular in nature, and could have been identified and prevented by measuring ethanol levels 10 min after ending the surgical procedure. The performance of such a test should be strongly recommended to all surgeons. The clinicians attributed the development of liver impairment in this case to ethanol toxicity. However, further studies are warranted to confirm whether hepatic injury can represent a possible complication of TUR syndrome when ethanol solution is used as irrigant fluid.

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“…The intravascular absorption of irrigation fluid during TURP has been shown to be approximately 700mL [3]. However, studies have demonstrated no significant intravascular absorption of irrigation fluid with PVP [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

Preparation for Avian Influenza: What is missing?

2008

IJID

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Transurethral resection of the prostate (TURP) is the gold standard treatment for bladder outlet obstruction. However, newer modalities, such as photoselective vaporisation of the prostate (PVP) have some significant advantages over TURP. Men who are candidates for transurethral resection of the prostate are suitable candidates PVP. The converse is not necessarily true. Patients who have an absolute requirement for anticoagulation can still be treated with PVP. We present a case study of two men at our centre with refractory urinary retention were considered unfit for TURP; both sought treatment with PVP. These men had an American Society of Anaesthesiology (ASA) Score of 4 and were also fully anti-coagulated with coumadin. Treatment was performed with the 120W lithium triborate laser. Both men successfully re-established urethral voiding and have maintained a good clinical outcome at over 2 years. This case report demonstrates that PVP may be performed safely and efficaciously in men despite medical co-morbidities, and whilst anti-coagulated.

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Monitoring of fluid absorption with nitrous oxide during transurethral resection of the prostate

Abstract: The N(2)O method does not require forced breath sampling and was successfully apply clinically. However, there was a dose-dependent difference in result between the ethanol and N(2)O methods, which markedly separated the limits of agreement for a wider range of fluid absorption events.

Cited by 10 publications

References 19 publications

Photoselective vaporization of the prostate in men taking clopidogrel

Photoselective vaporization of the prostate in men taking clopidogrel

Transient acute liver failure complicating transurethral resection syndrome

Preparation for Avian Influenza: What is missing?

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