The control of haemolysis during transurethral resection of the prostate when water is used for irrigation: monitoring absorption by the ethanol method

Hultén, Jan O.; Tran, Vi Thuy; Pettersson, Gösta

doi:10.1046/j.1464-410x.2000.00979.x

Cited by 10 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Water was used as irrigation fluid during resection due to non-availability of glycine and other irrigation fluids which were expensive to import. Distilled sterile water is cheap, available in abundance and safe as irrigation fluid in transurethral resections and though not proven in this study, the intravesical pressure was likely to be less than 40 cmH 2 O which is the critical pressure above which fluid is significantly absorbed [ 6 - 8 ]. There was no accurate record on the number of capsular perforations but they must have occurred in excess of the 15 recorded cases in this series but without serious consequences as regards TUR syndrome, haemolysis or significant haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Transurethral resection of the prostate in Northern Nigeria, problems and prospects

et al. 2008

View full text Add to dashboard Cite

BackgroundBenign prostatic hyperplasia (BPH) is the commonest disease of the urinary tract afflicting the ageing male and is the commonest neoplastic disease in men aged 50 years and above.Transurethral prostatectomy (TURP) is the ultimate treatment of choice for benign prostatic hyperplasia (BPH) due mainly to the preference of minimally invasive surgery, long term relief of symptoms and cost effectiveness. It is however not available to the majority of Nigerians in need of prostatic surgery in Public Health Institutions.MethodsThe records of patients who underwent prostatectomy in Aminu Kano Teaching Hospital, over the period June 2001 to July 2007 were examined. The bio data of patients and laboratory investigations performed were retrieved.ResultsFive Hundred and forty two patients were operated upon, out of which 40 were excluded due to open prostatectomy (22 patients), bladder neck stenosis (16 patients) or bladder tumour around the trigon (2 patients). The age range of the patients was 47–110 years with a mean of 67.2 years. 289 patients (80.1%) had urethral catheter in situ at presentation and 11 (3%) patients had suprapubic cystostomy of which only 3 (0.85%) had combined urethral stricture and BPH.Only 131 (26%) had their PSA measured which ranged from 2–100 ng/ml out of which 39(29.8% n = 131) patients had more than 4 ng/ml and cancer of the prostate and 1(0.8%, n = 131) patient had a PSA level of 4 ng/ml and malignant prostate.Hospital stay was 1–32 days (mean 7.9) and the mean follow up period was 5.6 months (range 0–60) and there were 17.5% complications comprising of urinary tract infection (UTI) 7.2%, Orchitis 2.2%, urinary incontinence 0.6%, atonic bladder 1%, erectile dysfunction 0.6%, cerebrovascular accident 0.4%, myocardial infarction 0.4%, deep vein thrombosis 0.4% and disseminated intravascular coagulopathy (DIC) 0.6% and 1.2% mortality. The cost of treatment inclusive of pre-admission investigations was US$ 615.00 (range US$ 300–1,300)ConclusionDespite advances in minimally invasive therapy for LUTH/BPH, TURP is the optimum treatment of choice for the ageing male of sub-Saharan Africa. It is however not available to the majority of patients in this region due to poor health allocation and inadequate facilities and training.

show abstract

Section: Discussionmentioning

confidence: 99%

Transurethral resection of the prostate in Northern Nigeria, problems and prospects

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Visual disturbances such as blurred vision, transient blindness, and pupillary dilation have been reported with TURP syndrome. There are clinical reports of transient blindness after absorption of 1.5% glycine which resolves within 24 h.[7] Different methods for assessing the fluid and electrolyte imbalance during TURP have been suggested which include the use of load cell transducers,[8] measurement of serum acid phosphatise,[9] assessment of breath ethanol,[10] and monitoring of plasma concentration of fluorescein. [11] Smoking is the only known risk factor, associated with fluid absorption during TURP as demonstrated by Hahn RG in 2001.…”

Section: Introductionmentioning

confidence: 99%

Electrolyte changes: An indirect method to assess irrigation fluid absorption complications during transurethral resection of prostate: A prospective study

et al. 2010

View full text Add to dashboard Cite

Context:Fluid absorption is inevitable complication of transuretheral resection of prostate and serum electrolytes changes can indirectly assess the irrigation fluid absorption.Aims:To monitor the extent of 1.5% glycineirrigation fluid absorption during transurethral resection of prostate (TURP), by measuring the changes of serum sodium and potassium levels peri-operatively.Settings and Design:This is a randomized prospective cohort observational study.Materials and Methods:The 86 male patients of ASA grades I to III in the age group of 50 to 80 years, scheduled for elective TURP surgery under central neuraxial block, were studied. Their preoperative and post-operative serum sodium, potassium and calcium levels were measured. When duration of surgery exceeds 60 min, serum sodium and potassium levels were done intra-operatively with venous blood samples by using blood gas analyser. The height of irrigation fluid column was kept constant at 60 cm. These changes were correlated with the volume of irrigating fluid used, duration of procedure and the volume of prostate gland resected.Statistical Analysis used:The values of pre and postoperative sodium, potassium and calcium serum levels were compared and statistical significance of the difference in values was assessed using Student’s paired t test.Results:Statistically significant reduction of serum sodium levels (hyponatremia) and elevation of serum potassium levels (hyperkalemia) were observed post-operatively, which was directly proportional to volume of irrigating fluid used, duration of procedure and volume of prostate gland resected. No significant changes in serum calcium level were observed.Conclusions:To measure serum electrolytes changes during TURP surgery, it is simple and economical method for indirect assessment of fluid absorption for early identification of TURP syndrome.

show abstract

“…The study comprised 46 patients scheduled for TURP at the author's institution; the study was approved by the Ethical Committee of the University of Umeå and the patients were included after providing informed consent. Some aspects and analyses of this group were presented previously [7]. All operations were undertaken with the patient under spinal anaesthesia, using a 24 F resectoscope and intermittent irrigation, and executed by two experienced urologists.…”

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

The control of haemolysis during transurethral resection of the prostate when water is used for irrigation: monitoring absorption by the ethanol method

Cited by 10 publications

References 7 publications

Transurethral resection of the prostate in Northern Nigeria, problems and prospects

Transurethral resection of the prostate in Northern Nigeria, problems and prospects

Electrolyte changes: An indirect method to assess irrigation fluid absorption complications during transurethral resection of prostate: A prospective study

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

Contact Info

Product

Resources

About