The Effect of Prostatic Capsule Perforation on the Absorption of Irrigating Fluid during Transurethral Resection

Salmela, L.; Aromaa, U.; Lehtonen, Timo; Peura, P.; Olkkola, Klaus T.

doi:10.1111/j.1464-410x.1993.tb16217.x

Cited by 16 publications

(16 citation statements)

References 16 publications

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“…8 It is likely that tissue ablation deep enough to reach the prostatic capsule, was not achieved with the 80W laser. Accordingly, intraoperative bleeding and capsular perforations, which are both risk factors for fluid absorption 11,17 were rare events during 80W LV. [18][19][20] Increased output power (120W) and a less extensive decrease of power output during the procedure due to improved laser fibers resulted in more extensive tissue ablation but also in more bleeding complications and capsular perforations during LV using second-generation laser.…”

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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“…Our exploratory analysis of risk factors for fluid absorption underlines the assumption that higher energy and injury of larger vessels are associated with the occurrence and the extent of fluid absorption [9,10]. In the absorber group a higher energy-to-prostate-volume ratio could be detected indicating a more extensive tissue ablation in this group.…”

Section: Resultsmentioning

confidence: 88%

“…The inability to put pressure on bleeding vessels impedes mechanical hemostasis making coagulation of larger vessels less effective. If opened vessels or sinuses are not coagulated or are not identified due to high intravesical pressure, influx of large volumes can occur [9,10]. Higher intravesical pressure is also associated with a higher velocity of fluid absorption [23].…”

Section: Resultsmentioning

confidence: 99%

“…capsular perforations, injury to prostatic sinuses or deep bladder neck incisions) [9,10]. Additionally, they rated the intraoperative bleeding intensity on a scale from 1 to 5 (1=no bleeding, 2=non-disturbing bleeding, 3=impaired visibility due to bleeding, 4=prolonged operation time due to bleeding, 5=termination of surgery due to bleeding).…”

Section: Methodsmentioning

confidence: 99%

“…Injury of venous sinuses or capsular perforations are known risk factors for fluid absorption during transurethral prostate surgery [9,10]. The XPS laser is equipped with a new pulsatile coagulation technology (TruCoag™) to improve intraoperative bleeding control [11].…”

Section: Introductionmentioning

confidence: 99%

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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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Irrigation fluid absorption during transurethral bipolar and laser prostate surgery: a systematic review

et al. 2021

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The Effect of Prostatic Capsule Perforation on the Absorption of Irrigating Fluid during Transurethral Resection

Cited by 16 publications

References 16 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

Irrigation fluid absorption during transurethral bipolar and laser prostate surgery: a systematic review

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