Validation of the ethanol breath test and on‐table weighing to measure irrigating fluid absorption during transurethral prostatectomy

Shipstone, David; Inman, Richard; Beacock, C. J. M.; Coppinger, S.W.V.

doi:10.1046/j.1464-410x.2002.03038.x

Cited by 17 publications

(17 citation statements)

References 41 publications

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“…In- and out-flow measurements are highly inaccurate [35]. Further possibilities are gravimetry [36], measurement of the patient's weight and of volumes of the irrigation fluid consumed and recovered [35], or isotopic labelling and measurement [37], or measurement of nitrous oxide [38] or glucose [39], all of which are, however, impracticable in a clinical context. In contrast, the ethanol-monitoring method is simple and safe, and fuel-cell breathalysers are not prone to interference by anaesthetic gases and so on.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Procedure-Specific Irrigation-Fluid Absorption in Transurethral Therapy of Lower Urinary Tract Syndrome, Using Ethanolic Saline and Breath Alcometry

Porsch

Mittelstädt²,

Wendler³

et al. 2016

Urol Int

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Introduction: Transurethral resection risks excessive absorption of irrigating fluid with potentially severe or life-threatening consequences. We determined the amount of absorbed saline irrigation fluid during photoselective vaporisation of the prostate (PVP) and bipolar transurethral resection of the prostate (bTURP). Patients and Methods: Patients at our institution treated by one of these methods were monitored by the alcometric method: ethanol is added to the irrigation fluid and blood alcohol is measured with a breathalyser. Various possible correlations were investigated. Results: Data from 71 patients (36 PVP, 35 bTURP) were analysed. Detection of any absorption was more frequent under bTURP (71% of patients) than under PVP (39%; p = 0.006). Absorption in the volume range 500-1,000 ml was conspicuously more frequent in the bTURP procedure than in PVP. Conclusions: Presence of absorption was more frequent under bTURP than under PVP. However, high-volume absorption was more frequent during bTURP than in PVP.

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Section: Discussionmentioning

confidence: 99%

Measurement of Procedure-Specific Irrigation-Fluid Absorption in Transurethral Therapy of Lower Urinary Tract Syndrome, Using Ethanolic Saline and Breath Alcometry

Porsch

Mittelstädt²,

Wendler³

et al. 2016

Urol Int

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“…[919] The ethanol breath test was chosen because it is fairly accurate, inexpensive in comparison and user-friendly. [10] Moreover, readings are not affected by spillage of irrigating fluid and administration of intravenous infusions, because of rapid and equal distribution of ethanol in all body compartments.…”

Section: Discussionmentioning

confidence: 99%

Comparison of fluid absorption during transurethral resection of prostate and Holmium-Yag laser enucleation of benign adenoma of prostate using breath ethanol concentration

Bapat¹,

Umranikar²,

Satav³

et al. 2007

Indian J Urol

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Objective:We conducted a study to detect, quantify and compare irrigation fluid absorption in transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP), using BEC.Materials and Methods:The study included 50 patients of lower urinary tract symptoms, secondary to benign enlargement of prostate. The patients were nonrandomly allocated to undergo TURP and HoLEP. Twenty-six patients underwent TURP and the remaining 24 underwent HoLEP. Sterile water tagged with 1% ethanol w/v was used for irrigation. Absorption was detected and quantified every 10min by BEC levels. Data was analyzed using standard nomograms.Results:In HoLEP, 14/24 had no fluid absorption. The remaining 10/24 showed fluid absorption ranging from 95 ml to 300 ml. In TURP, all had fluid absorption ranging from 250-980 ml. Three TURP patients developed overt symptoms, while none did in the HoLEP group.Conclusions:Fluid absorption observed in our study in the HoLEP group was lower than in the TURP group.

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“…These adverse effects can be ascribed to dilutional hyponatraemia, resulting from excessive absorption of irrigating fluid, as well as the direct toxicity of glycine. Subsequently, the addition of ethanol 1% to the solution has allowed the monitoring of its reabsorption by assessment of alcoholaemia, using an exhaled ethanol analyser during TURP [3]. The risk of developing alcohol-dependent toxicity seems to be very low and this irrigation fluid has gained wide acceptance among surgeons.…”

Section: Introductionmentioning

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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Validation of the ethanol breath test and on‐table weighing to measure irrigating fluid absorption during transurethral prostatectomy

Cited by 17 publications

References 41 publications

Measurement of Procedure-Specific Irrigation-Fluid Absorption in Transurethral Therapy of Lower Urinary Tract Syndrome, Using Ethanolic Saline and Breath Alcometry

Measurement of Procedure-Specific Irrigation-Fluid Absorption in Transurethral Therapy of Lower Urinary Tract Syndrome, Using Ethanolic Saline and Breath Alcometry

Comparison of fluid absorption during transurethral resection of prostate and Holmium-Yag laser enucleation of benign adenoma of prostate using breath ethanol concentration

Transient acute liver failure complicating transurethral resection syndrome

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