Intravesical pressure during irrigating fluid absorption in transurethral resection of the prostate.

Abstract

In order to control fluid absorption, various approaches are used to reduce intravesical pressure during transurethral resection of the prostate (TURP). With a view to finding a target pressure for such efforts, pressure and fluid absorption were compared in a meta-analysis of four previous studies comprising three different irrigation techniques. Intravesical pressure was recorded during TURP in which the irrigating fluid was evacuated intermittently (n = 48) by a suprapubic tube (n = 23) or a trocar (n = 30). Fluid absorption was compared with the mean and maximum pressures and the duration of excessive pressure (>2 kPa) over 10-min periods. Mean bladder pressure during fluid absorption was between 1.0 and 2.5 kPa. The maximum pressure during absorption varied greatly during the first 30 min of TURP, but thereafter it ranged between 2 and 3 kPa. Only the duration of pressures >2 kPa increased with fluid absorption (p < 0.02). The maximum pressures were highest with the intermittent technique, while the other indices of intravesical pressure showed the highest values when the suprapubic tube was used. The lowest pressures usually occurred when the trocar was used, but fluid absorption still occurred, as the pressure was much higher during some of these operations. Fluid absorption occurred at moderate intravesical pressures with all three irrigation techniques. The best strategy for reducing fluid absorption is to keep the pressure below 2 kPa for as long as possible during TURP.