2021 PROSPECTIVE EVALUATION OF IRRIGANT ABSORPTION DURING PURE TRANSURETHRAL BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE BY EXPIRED BREATH ETHANOL MEASUREMENTS

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology II1 Apr 20122021 PROSPECTIVE EVALUATION OF IRRIGANT ABSORPTION DURING PURE TRANSURETHRAL BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE BY EXPIRED BREATH ETHANOL MEASUREMENTS Christian Daniel Fankhauser, Lukas John Hefermehl, Benedikt Kranzbühler, Oliver Gross, Marian Severin Wettstein, Nico Grossmann, Janine Corinne Capol, Matthias Zimmermann, Tullio Sulser, Alexander Müller, and Thomas Hermanns Christian Daniel FankhauserChristian Daniel Fankhauser Zürich, Switzerland More articles by this author , Lukas John HefermehlLukas John Hefermehl Zürich, Switzerland More articles by this author , Benedikt KranzbühlerBenedikt Kranzbühler Zürich, Switzerland More articles by this author , Oliver GrossOliver Gross Zürich, Switzerland More articles by this author , Marian Severin WettsteinMarian Severin Wettstein Zürich, Switzerland More articles by this author , Nico GrossmannNico Grossmann Zürich, Switzerland More articles by this author , Janine Corinne CapolJanine Corinne Capol Zürich, Switzerland More articles by this author , Matthias ZimmermannMatthias Zimmermann Zürich, Switzerland More articles by this author , Tullio SulserTullio Sulser Zürich, Switzerland More articles by this author , Alexander MüllerAlexander Müller Zürich, Switzerland More articles by this author , and Thomas HermannsThomas Hermanns Zürich, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2184AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral bipolar plasma vaporisation (BPV) has been introduced as a minimal invasive alternative for conventional transurethral resection of the prostate (TURP). Especially high-risk patients may profit from irrigation with isotonic saline and from the excellent haemostatic properties of the so-called “mushroom electrode”. Those characteristics allow for a nearly bloodless operation and prevent the development of a TUR syndrome. However, it is unknown if irrigant absorption per se is prevented during BPV. METHODS A total of 55 consecutive patients were prospectively investigated between 07/2010 and 09/2011 during routine pure BPV using the TURIS HF system (Olympus GmbH, D). Intraoperative irrigation was performed with isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min during the operation using an AlcoQuant 602 alcometer (r-Technik GmbH, D). The volume of irrigant absorbtion was then calculated from these concentrations using an established nomogram. Additionally, intraoperative changes in serum electrolyte and heamoglobin concentrations were recorded. RESULTS The median patients' age was 67 y (48-88 y) and median prostate volume was 41.4 ml (21-89 ml). The median operation time was 70 min (30-140 min) and median irrigation volume 21 l (3-39 l). A total of 9 patients (16.4%) showed a positive ethanol breath test during BPV. The median calculated fluid absorption in those patients was 230 ml (range: 50-2000 ml). Significant changes in electrolyte or haemoglobin concentrations were not detectable. Only one patient with an irrigant absorption of 2 l showed clinical symptoms in form of mild dyspnoea and agitation. The surgeons reported capsular perforation, opening of large prostatic sinuses or a deep bladder neck incision in all patients with detectable fluid absorption. CONCLUSIONS Significant fluid absorption occurs during BPV of the prostate despite the excellent haemostatic properties of the “mushroom electrode”. Isotonic saline irrigation prevents the development of a dreaded TUR-syndrome with serious serum electrolyte changes. However, absorption of large isotonic volumes can also be dangerous especially for patients with e.g. cardiac insufficiency. It is important to know that fluid absorption cannot be monitored by intraoperative electrolyte measurements. Respecting the anatomical boundaries of the prostate seems to play a major role in preventing fluid absorption during BPV. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e815-e816 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Daniel Fankhauser Zürich, Switzerland More articles by this author Lukas John Hefermehl Zürich, Switzerland More articles by this author Benedikt Kranzbühler Zürich, Switzerland More articles by this author Oliver Gross Zürich, Switzerland More articles by this author Marian Severin Wettstein Zürich, Switzerland More articles by this author Nico Grossmann Zürich, Switzerland More articles by this author Janine Corinne Capol Zürich, Switzerland More articles by this author Matthias Zimmermann Zürich, Switzerland More articles by this author Tullio Sulser Zürich, Switzerland More articles by this author Alexander Müller Zürich, Switzerland More articles by this author Thomas Hermanns Zürich, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...