Absorption Of Irrigating Fluid Research Articles

Risk factors of high fluid absorption in patients treated with mini-PCNL: a single-center prospective study.

The factors influencing fluid absorption in mini-percutaneous nephrolithotripsy (mini-PCNL) are still unknown. We aim to investigate the factors that influence irrigation fluid absorption during mini-PCNL. A total of 94 patients who underwent mini-PCNL were included in this prospective study. The endoscopic surgical monitoring system (ESMS) was used to measure the volume of irrigation fluid absorbed during the procedure. Irrigating time, the total volume of irrigation fluid, stone size, S.T.O.N.E. score, hemoglobin, electrolyte levels, and postoperative complications were recorded. A significant correlation was observed between fluid absorption and the presence of postoperative fever, and based on this phenomenon, patients were divided into low and high fluid absorption groups. The serum creatinine level in the high fluid absorption group was significantly high (7 vs. 16.5, p = 0.02). Significant differences were observed between the low and high fluid absorption groups in terms of mean stone size (21.70 mm vs. 26.78 mm), presence of stone burden ≥ 800 mm2 (4% vs. 23%), S.T.O.N.E. score > 8 (4% vs. 38%), the fluid used > 18,596 ml (19% vs. 78%), irrigation time (55.61 min vs. 91.28 min), and perfusion rate (24% vs. 45%) (all p < 0.05). The rates of postoperative fever and SIRS in the high fluid absorption group were significantly high (p < 0.05). Mean stone size, presence of stone burden ≥ 800 mm2, S.T.O.N.E. score > 8, the fluid used > 18596 mL, irrigation time, and perfusion rate are risk factors of intraoperative fluid absorption in mini-PCNL.

Rezum: a novel transurethral water vapor therapy for benign prostatic hyperplasia

Rezum: a novel transurethral water vapor therapy for benign prostatic hyperplasia

Correlation between post-operative electrolyte changes to perioperative factors in Bipolar TURP

Background: Transurethral resection of the prostate (TURP) is one of the best available treatments for benign hypertrophy of the prostate. Many of the complications in TURP are associated with the absorption of irrigation fluid. In BIPOLAR TURP, normal saline is used as an irrigant which is more physiological. Aims and Objectives: Our aim of the study is to evaluate the correlation between post-operative electrolyte changes to perioperative factors in bipolar TURP. Materials and Methods: One hundred and ten patients enrolled in this study who were admitted to Meenakshi Mission Hospital, Madurai, Tamil Nadu, India. Results: Mean age of the participants was 65.68 (±8.50) years with a median of 66 years. mean hemoglobin drop was 1.21 (±1.36) g/dl. The mean serum sodium drop was 1.55 (±3.01) mEq/L. The mean serum potassium change was 0.06 (±0.74) mEq/L. There was a significant positive association between operative time and serum sodium drop (P&lt;0.001). There was no significant correlation between any of the other parameters prostate size, resection time, resected volume were noted, and post-operative electrolyte April 2019–March 2021. Patient pre-operative changes and hemoglobin drop is observed. Correlation is assessed with Spearman Rho. Conclusion: Our study concluded that as operative time increases sodium drop and hemoglobin drop significantly increases. Resected and pre-operative prostatic volumes do not affect electrolyte and hemoglobin levels.

Evaluation of fluid absorption during flexible ureteroscopy in an in vivo porcine model.

To evaluate the relationship between renal pelvis pressure and fluid absorption during ureteroscopy (URS) in a live porcine model. Flexible URS (fURS) was performed in anaesthetised female Yorkshire pigs. Prior to performing fURS, a 0.3556-mm (0.014″) pressure-sensing guidewire (Comet™, Boston Scientific) was placed to monitor renal pelvis pressure. A simulated fURS procedure was then performed for 1 h. Infusion of irrigation fluid (5% ethanol in saline) at target renal pelvis pressures (37-150 mmHg) was maintained for 1 h using a pressure bag and real-time feedback from the pressure-sensing guidewire. Venous blood was sampled every 10 min. The volume of irrigation fluid absorbed was estimated with established equations. A URS procedure was performed in vivo in 18 porcine kidneys and the volume of irrigation fluid absorbed during the 1 h URS was calculated. The mean (SD) volume of irrigation fluid absorbed after 1 h of simulated URS was 7.6 (5.7), 10.8 (7.1), 26.0 (15.8), and 56.8 (22.3) mL at renal pelvis pressures of 37, 55, 75, and 150 mmHg, respectively. Compared with URS with renal pelvis pressure of 37 mmHg, the volume of fluid absorption was significantly greater at renal pelvis pressures of 75 and 150 mmHg (P = 0.026 and P = 0.047, respectively). In addition, compared with URS with renal pelvis pressure of 37 mmHg, the rate of absorption was significantly greater at renal pelvis pressures of 75 and 150 mmHg (both P < 0.001). In this study of an in vivo porcine model of URS, increasing renal pelvis pressures during URS were associated with increases in irrigation fluid absorption and increases in the rate of fluid absorption.

1.5% Glycine vs 5% Glucose Irrigant During TURP on Serum Electrolytes &amp; TUR Syndrome” Which One is Better?

Objective: To observe the changes in the serum electrolytes and occurence of the transurethral resection syndrome (TUR) with 1.5% glycine and 5% glucose as an irrigant fluid during TUPR Patients and methods: Between June 2008 and May 2010, 120 patients were included in a prospective comparative trial comparing 1.5% glycine with 5% glucose irrigation fluids. We measured blood loss, fluid absorption, biochemistry including serum electrolytes RBS and peri-operative symptoms. Blood samples were taken before and immediately and 24 h after TURP. Irrigating fluid absorption during TURP was measured by serum sodium level. Operative details were recorded, including the type of anaesthesia (with or with no sedation), resection time and weight of resected tissue. Peri-operative symptoms were documented prospectively. TUR syndrome was defined as a serum sodium level of £125 mmol/L with two or more associated symptoms or signs of TUR syndrome. Results: Two (1.67%) patients had TUR syndrome; all two were irrigated with glycine, although this difference was not statistically significant (P = 0.10). Of the two patients who had TUR syndrome, one had bradycardia, two had hypotension, two were drowsy, one was nauseous, two had prickling sensation, two experienced uneasiness, one had blurred vision and two were confused; none had chest pain. There was no difference between the groups in levels of sodium, potassium, urea, creatinine or peri-operative blood loss (defined as a change from before to after TURP in haemoglobin level, accounting for transfusions). Conclusions: Endoscopic transurethral resection of the prostate performed using 5% glucose as irrigating solution during surgery, when compared with 1.5% glycine are associated with lower perioperative morbidity including TUR syndrome. Except for the transient postoperative hyperglycemia, in glucose group, both irrigants are nearly equivalent &amp; safe. In other studies, glycine was reportedly toxic, and that the levels recorded were many times the upper limit of normal may have both immediate and long-term effects Bangladesh J. Urol. 2021; 24(1): 9-13

Symptomatic absorption of normal saline during transurethral resection of the prostate: a case report

BackgroundTransurethral resection of the prostate (TUR-P) could incidentally cause hyponatremia, known as TUR syndrome due to intravascular absorption of non-electrolytic irrigation fluid. Recently, normal saline has been used as an irrigation fluid in a new system named TURis (TUR in saline) to prevent TUR syndrome. However, rapid massive absorption of normal saline can also cause other systemic adverse events.Case presentationA 71-year-old man underwent TURis for benign prostatic hyperplasia under spinal anesthesia. The patient lost consciousness which led upper airway obstruction and hypoxia 30 min after the surgery began. Blood gas test indicated hyperchloremic metabolic acidosis. While vasoactive agents were ineffective, the administration of bicarbonate significantly improved the symptoms and restored blood pressure.ConclusionWe experienced a case of hyperchloremic metabolic acidosis with decreased level of consciousness and hypotension during TURis. Administration of bicarbonate, but not phenylephrine, was effective for recovering blood pressure.

The Effect of Intraoperative Oxytocin Infusion on Irrigation Fluid Absorption During Hysteroscopic Myomectomy: A Randomized Placebo-Controlled Double-Blind Trial

Objectives: One of the most prevalent benign tumors in women is uterine leiomyoma. Large quantities of fluid absorbed during myomectomy may cause serious problems such as volume overload and hyponatremia. The aim was to see how intraoperative oxytocin infusion affected irrigation fluid absorption in individuals having hysteroscopic myomectomy. Materials and Methods: 50 women between 25-45 years who underwent hysteroscopic myomectomy and had an American Society of Anesthesiologists class I or II were evaluated in this randomized, double-blind clinical trial study. A 250 mL ringer solution containing 15 units of oxytocin was administered at a 125 mL/h in the oxytocin group (group S). In contrast, the placebo group (group P) received 1.5 mL of normal saline in the same amount of Ringer solution. Intraoperative hemodynamic alterations, fluid deficit, decreased hemoglobin, hematocrit, sodium, and albumin levels from baseline, complications, and the incidence of toxicity with the administered solutions were assessed intraoperative and 24 hours later. Results: Group S had considerably reduced irrigation fluid volume (P=0.021) and volume deficit (P=0.001). The frequency of hypotension in individuals receiving oxytocin did not differ significantly from the placebo group (P=0.26). In group S, serum hematocrit (P=0.036) and sodium (P=0.026) were decreased significantly. Conclusions: Intraoperative oxytocin infusion during hysteroscopic myomectomy may be associated with reduced irrigation fluid absorption and the problems that come with it. As a result, this approach might decrease the risks associated with high amounts of irrigation fluid being absorbed during hysteroscopic myomectomy.

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

Transurethral endoscopic procedures using bipolar current, or laser energy are nowadays widely accepted and have replaced the traditional monopolar resection. A major advantage of these techniques is the utilization of isotonic saline as irrigation solution, which minimizes side effects such as symptoms associated to classical transurethral resection syndrome (TUR-syndrome). Nonetheless, clinically significant IFA also occurs with saline and is determined by pressure gradients, systemic resistance and by the amount of irrigation fluid. We aimed to investigate the extend of IFA and symptoms due to volume overload during bipolar transurethral resection (bTUR) and laser procedures of the prostate. We performed a systematic literature search using PubMed, restricted to original English-written articles, including animal, artificial model, and human studies. Search terms were TUR, transurethral, laser, HoLEP, ThuLEP, greenlight, enucleation, fluid absorption, fluid uptake, and TUR-syndrome. Mean and maximum IFA during bTURP ranges between 133 and 915ml and 1019ml and 2166ml, respectively. Absorption during laser procedures can be significant with maximum values up to 4579ml and mainly occurs during prostate vaporization techniques. Incidence of moderate to severe symptoms from iso-osmolar volume overload reaches 9%. Irrigation fluid absorption during bTUR and laser surgery of the prostate is not negligible. Iso-osmolar overhydration with development of non-classical TUR-syndrome should be identified peri- and postoperatively and surgical teams should be aware of complications. Breath ethanol, venous pH, serum chloride, and bicarbonate could be markers for detecting dangerous events of IFA with saline.

Üreter Taşı Hastalarında Postüreteroskopik Lezyon Skalası ile Emilen Irrigasyon Sıvısı Arasında Bağlantı Var Mı?

Objective: Post-Ureteroscopic Lesion Scale (PULS) is used to classify ureteral wall injury that occurs during ureteroscopy. In this study we presented the preliminary results of absorbed irrigation fluid volumes according to PULS grades. Material and Methods : Forty-four patients to whom 7F semirigid ureteoscopy was performed due to ureteral stone were included in the study. All patients received general anesthesia. Izotonic containing 1% ethanol was used as irrigation fluid. Ethanol concentration in venous blood was commenced to be measured at the start of irrigation use and was carried on at 15-minute intervals including the post-operative period in the recovery room. Absorbed fluid volume was calculated by using blood ethanol concentrations. Irrigation time, stone size and PULS grade were recorded. Results : Mean operation time was found to be 44.2 ± 19.9 minutes. Mean stone size was measured to be 12.7± 6 mm and mean irrigation fluid amount used was 1371±1262 ml. PULS grade of 0 was seen in 26 patients and that of 1 or more was seen in 18 patients. No patient had a PULS grade of 3 or 4. Mean absorbed fluid volume was measured to be 58 ± 50,6 ml. No significant correlation was found between PULS grade and mean absorbed fluid volume. Conclusion: Fluid absorption during URS is not correlated with the PULS grade. Semirigid URS is a safe treatment option for ureteral stone disease in terms of the level of irrigation fluid being absorbed.

Changes in Cardiovascular Status and Serum Electrolyte Levels During Percutaneous Nephrolithotomy

Background: Due to advancement of endourology, percutaneous nephrolithotomy (PCNL) is a common procedure for removal of renal stones. Intravascular absorption of normal saline during the PCNL may result in fluid overload, electrolyte imbalance and cardiovascular instability.&#x0D; Objective: To evaluate the changes in cardiovascular status and serum electrolyte levels in patients undergoing percutaneous nephrolithotomy. Method: Sixty adults underwent percutaneous nephrolithotomy were studied. Among them male female ratio was 13:7 and age ranging from 20-50 years. Heart rate, blood pressure and serum electrolytes were monitored before irrigation, during irrigation and post operatively. Stone size, duration of irrigation, volumes of irrigation fluid used and amount of absorption of irrigation fluid were recorded.&#x0D; Result: The mean heart rate, systolic and diastolic blood pressure levels were significantly higher (p&lt;0.05) during PCNL compared to base line values. Serum sodium, potassium levels were decreased during the operation compared to the baseline levels (p &lt; 0.005) but mean chloride concentration increased gradually compared to baseline but it was significantly higher at 120th min of irrigation and postoperatively (p&lt;0.05). There was no significant change of serum bicarbonate concentration compared to base line value (p&gt;0.05). The volume of irrigation fluid varied from 10000 ml to 24000 ml with mean volume 17045(±3383) ml. Total duration of irrigation varied from 30 min to 120 min. Total absorbed irrigant varied from 200-1000 ml with mean volume absorbed 526.27(±215) ml.&#x0D; Conclusion: In conclusion, these changes in cardiovascular status and serum electrolyte levels during percutaneous nephrolithotomy (PCNL) may be due to the invasive nature of the intervention to the kidney and the continuous irrigation of this vital organ.&#x0D; Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.3-7

Comparison of intrarenal pelvic pressure and postoperative fever between standard- and mini-tract percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized controlled trials.

BackgroundHigh intrarenal pelvic pressure (IPP) induces systemic absorption of irrigation fluid containing bacteria or endotoxins, which is associated with postoperative fever (POF) and even urosepsis. The emphasis of this meta-analysis lies in comparison of IPP and POF between mini-tract percutaneous nephrolithotomy (MPCNL) and standard-tract percutaneous nephrolithotomy (SPCNL).MethodsEligible randomized controlled trials (RCTs) were identified from electronic databases from inception to November 2019. Studies selection, quality assessment, data extraction and analysis were accomplished by two independent reviewers using Cochrane Collaboration’s tools.ResultsPatients in the MPCNL group experienced higher IPP compared to SPCNL group [mean difference (MD): 8.31, 95% confidence interval (CI): 3.67–12.96, P=0.0005] with highly between-study heterogeneity (P=0.001, I2=85%). Notably, the IPP was higher in MPCNL group in different stages of the procedure including introduction, fragmentation and end. However, only two trials were available for pooled analysis. Additionally, the risk of POF in MPCNL was 2.43 times higher than that in SPCNL [odds ratio (OR): 2.43, 95% CI: 1.39–4.27, P=0.002] with no significant between-study heterogeneity (P=0.83, I2=0%). The two procedures was comparable on stone-free rate (SFR) (OR: 1.06, 95% CI: 0.61–1.86, P=0.83) and operation time (MD: 5.69, 95% CI: −4.54 to 15.91, P=0.28).ConclusionsCurrent evidence indicates that MPCNL is an effective alternative to SPCNL with comparable SFR. IPP and POF is significantly higher during MPCNL compared to SPCNL. Intraoperative detection of IPP is of great significance for ensuring safety and reducing postoperative complications, especially for patients with MPCNL and the duration of stone fragmentation. Further large well-designed trials are warranted to confirm our findings.

Novel strategy to monitor fluid absorption and blood loss during urological endoscopic surgery.

BackgroundThere is paucity of an optimal method to detect fluid absorption and hemorrhage during urological endoscopic surgery. We designed an endoscopic surgical monitoring system (ESMS) and estimated its performance to establish a practical instrument that can monitor the blood loss and fluid absorption accurately and non-invasively during urological endoscopic surgery.MethodsOur system employed the strain gauge transducers to detect the inflows and outflows of the irrigating solutions and the photoelectric sensor to determine the hemoglobin concentration of the collected irrigating fluid. The amount of blood lost and the volume of fluid absorbed during endoscopic surgery could be calculated by computer program. The accuracy and validity of this system were validated in simulated experiment and clinical study of 200 patients who underwent transurethral resection of the prostate (TURP).ResultsThe relative errors for fluid absorption detection were between 0.07% and 1.00% and the coefficient of variation in serial analysis ranged from 0.78% to 3.86%. Furthermore, the relative errors for blood loss detection were between 0.06% and 1.33% and the coefficient of variation in serial analysis ranged from 0.86% to 3.94%. In clinical study for TURP, the mean fluid absorption was 644 mL and blood loss was 238 mL.ConclusionsWe provide the accuracy and validity of ESMS. It provides an early and real time detection and warning of irrigation fluid absorption and blood loss to make endoscopic surgical procedure safer for the patient.

Usefulness of non-invasive cardiac output monitoring in elderly patients undergoing monopolar transurethral resection of the prostate: a pilot study.

ObjectiveTo assess the impact of irrigating fluid on hemodynamic profiles using real-time non-invasive cardiac output monitoring (NICOM) in elderly patients undergoing monopolar transurethral resection of the prostate (TURP).MethodsTwenty patients between 65 and 80 years of age who were scheduled for monopolar TURP and received spinal anesthesia up to T10 were enrolled. Irrigating fluid (2.7% sorbitol with 0.5% mannitol solution) was used. Hemodynamic profiles including cardiac index, and stroke volume variation (SVV) using NICOM were obtained. Estimated irrigating fluid absorption was indirectly calculated.ResultsThe median amount of irrigating fluid used was 6000 mL. The median SVV was 11%, which increased to 12% at 10 minutes after initiating surgery. No significant changes in the cardiac index were observed. The estimated absorption of irrigating fluid was almost zero.ConclusionsAlthough the estimated amount of irrigating fluid that was absorbed was negligible, the increase in SVV may indicate intravascular volume depletion with diuresis resulting from mannitol in the irrigating fluid early during irrigation. Therefore, even during short irrigating times, intensive hemodynamic monitoring should be performed to monitor the possibility of intravascular volume depletion as well as volume overload, especially immediately after large amounts of irrigating fluid are used.

Intraoperative water intoxication and hypothermia in a patient undergoing hysteroscopic submucosal fibroid resection

Hysteroscopy is a useful diagnostic tool as well as a treatment option in many of the gynecological procedures. Although hysteroscopic procedures are generally safe in expert hands, the clinicians can face complications during and after the procedure. One of the intraoperative complications is water intoxication during the procedure. The pathophysiology and treatment of this complication are similar to the TURP syndrome. Hypothermia due to the absorption of cold irrigation fluid is another complication we must be aware of. Vigilant monitoring and choice of regional anesthesia can help early detection and prevention of these complications.

Biochemical Changes Using Sterile Water and 1.5% Glycine in TURP: A Randomized Study

Introduction: Endoscopic procedures in urology require irrigating fluid to provide a clear field of vision and to wash away debris. Glycine (1.5%) has been widely used, however sterile water is easily available and inexpensive. Excessive absorption of irrigation fluid can lead to dyselectrolytemia, hemolysis and systemic complications. In this study we compare 1.5% glycine with sterile water as irrigation fluid for Trans Urethral Resection Of Prostate (TURP). Materials and Method: In this prospective randomized study, we analysed 60 patients with symptomatic Benign Prostatic Hyperplasia (BPH) undergoing TURP with either 1.5% glycine or sterile water as irrigation fluid. The duration of surgery, weight of prostate resected, volume of fluid absorbed were compared. Post-operative levels of hemoglobin, hematocrit, electrolytes and renal function tests at 15 mins, 3 hrs and 6 hrs were analysed. Results: The mean decrease in hemoglobin at 6 hrs was more with 1.5% glycine (1.05±0.28 vs 0.89±0.14g/dL) and was statistically significant (P = 0.031). The mean fall in haematocrit at 6 hrs was significantly more with 1.5% glycine (4.87±1.41 vs 3.94±1.32%) (P = 0.046). The post-operative levels of blood urea were significantly less with 1.5% glycine at 15 mins, 3 hrs and 6 hrs (P 0.05). Nine patients (30%) who received 1.5% glycine and 8 patients (26.6%) receiving sterile water had dilutional hyponatremia at 6 hrs, but there were no significant difference between the two groups (P = 0.38). None of the patients developed TURP syndrome. Conclusion: Biochemical changes with sterile water was significantly less when compared with 1.5% glycine in TURP. Most of the changes observed were at 6 hrs after surgery. Hence sterile water can be considered as a safer and inexpensive alternative to glycine in resource-limited settings of low-income countries.

A STUDY OF PERIOPERATIVE COMPLICATIONS AND ITS CORRELATION WITH AMOUNT OF IRRIGATION FLUID USED IN PATIENTS UNDERGOING SHOULDER ARTHROSCOPY

Introduction: Arthroscopic shoulder surgery is a minimally invasive technique performed for diagnostic and therapeutic purposes. Advances in arthroscopy permit many procedures to be performed primarily or adjunctively through the arthroscope. Commonest indications of shoulder arthroscopy is usually performed for Shoulder instability, Bankart’s lesion, Supraspinatus tear, Meniscus tear, Impingement syndrome, Rotator cuff tears, Calcific tendonitis tendinitis and Frozen shoulder. Recent evidences, however, have increasingly focused on complications related to use of irrigation fluid, patient positioning and anaesthesia during shoulder arthroscopy. The risk of complications can be reduced with an experienced surgeon, lesser surgical duration, use of controlled pump pressures and controlled flow rate of irrigation fluids.&#x0D; Material and Methods: The present prospective study involves an analysis of perioperative monitoring of effects of amount of irrigation fluid in patient undergoing shoulder arthroscopy. With objective to see the Effect of irrigation fluid absorption on measurable parameters and to identify whether these parameters help in predicting airway/ respiratory compromise or cardiac complications.All the patients of any ASA Grade, sex and above 18 years who were posted for shoulder arthroscopy were included in the study. 72 patients who were undergoing shoulder arthroscopy were invited to participate in this observational study. Complete histories were obtained and thorough clinical examination was carried out. Brachial plexus block with general anaesthesia were given to all the patients.&#x0D; Results: Out of 72 patients 54(75%) were males and 18(25%) were females.30 litres or less irrigation fluid is used in 47(65.3%) patients, between 30-40 litres is used in 24(33%) patients and 40 litres or more irrigation fluid is used in 1( 1.4%) patient. Baseline pulse rate was 79.85±8.11 per minutes, which started decreasing from T4 (1.4%) to throughout the procedure and this fall was found to be statistically significant. The maximum fall in pulse rate at 160 minutes (19.8%). Pulse rate increases from 200 minutes till the end of the surgery. Baseline mean BP was 101.63±7.90 mm Hg, which started decreasing from T1 (16.1%) to throughout the procedure and this fall was found to be statistically significant. the leak test and delayed extubation in patients undergoing shoulder arthroscopy. Towards the end of procedure and prior to extubation 4(5.6%) patients showed negative leak test and hence, had delayed extubation, and 68(94.4%) patients showed positive leak test and normal extubation and statistically significant. Mid arm circumference was increased by 14.2%, neck circumference was increased by 10.4%, haemoglobin (Hb) was decreased by 6.6%, serum sodium (Na) was decreased by 4.6% and serum potassium (K) was decreased by 16.2%. Post-operative changes in all these parameters was found to be statistically significant.&#x0D; Conclusion: Extravasation of irrigation fluid used during shoulder arthroscopy can be disastrous leading to various complications like airway oedema, tracheal compression extensive subcutaneous emphysema, pneumomediastinum, tension pneumothorax and air embolism. The risk of regional and systemic absorption of irrigation fluid is directly proportional to amount of irrigation fluid used and duration of surgery. The measurement of neck circumference can be a clinical predictor for airway oedema following shoulder arthroscopy. We recommend to with hold extubation when the neck circumference increases by more than 6 cm

A Comparison of Hemostatic Properties between Monopolar and Bipolar Hysteroscopic Surgery using Rotational Thromboelastometry: A Randomized Trial

Objective: Systemic absorption of irrigation fluid can lead to a disturbed coagulation cascade. We compared the changes in hemostatic properties on using nonelectrolyte solution in monopolar hysteroscopic surgery (HS) with that on using isotonic saline in bipolar HS via rotational thromboelastometry (ROTEM) analysis. Methods: A total of 54 patients were randomized into 2 groups: 1 group underwent monopolar HS using a mixture of 2.7% sorbitol and 0.54% mannitol (the HS_MP group), whereas the other group underwent bipolar HS using 0.9% isotonic saline (the HS_BP group). The effects of these 2 methods on coagulation were assessed via pre and postoperative laboratory tests, including estimation of the international normalized ratio of prothrombin time and activated partial thromboplastin time and ROTEM analysis. In addition, the hemoglobin, hematocrit, and electrolyte levels and the platelet count were analyzed. Results: Patient characteristics, volume of irrigation fluid absorbed, and type of procedure were comparable between the 2 groups. There were no significant differences in the pre and postoperative values of ROTEM parameters between the 2 groups. Most postoperative ROTEM parameters, as compared with preoperative values, changed in both groups; clot formation time was prolonged, and the α-angle and maximum clot firmness were decreased. All ROTEM parameters were maintained within the normal range. Hematological parameters, including hemoglobin and hematocrit levels and platelet count, were significantly decreased postoperatively in both groups compared to the preoperative values. No pre and postoperative hematological and hemostatic parameters were significantly different between the 2 groups. Conclusion: Irrigation fluid absorbed in healthy women during HS caused hypocoagulable changes in the blood, irrespective of the irrigant type, and no significant differences between HS using monopolar and bipolar electrodes were demonstrated.

Surveillance study of irrigating fluid absorption and bleeding in transurethral resection of the prostate

Objective To investigate the effect of the endoscopic surveillance system in irrigating fluid absorption and bleeding during transurethral resection of the prostate. Methods In vitro trials, we simulated the fluid absorption and bleeding in the operation by using self-developed endoscopic surveillance system from January 2013 to June 2013. Continuous irrigation of 5% mannitol solution, we extracted 5 times irrigating fluid (each time 100 ml and a total of 500 ml) in the process of irrigation and recorded absorption measurements of every time extraction rinses. At the same time, we dripped human whole blood 5 times(each time 5 ml and a total of 25 ml) in the process of irrigation and recorded the bleeding measurements. The above process was repeated three times to detect the accuracy and consistency of the endoscopic surveillance system. In clinical trials, 50 cases of BPH were monitored in surgery and the biochemical index, hemodynamics, irrigating fluid absorption and bleeding were compared from October 2016 to April 2017.The included criteria contained as follow: the age of patients should be more than 50 years. The transabdominal ultrasound showed that the volume of prostate should be more than 60 ml. The maximal uroflowmetry should be less than 15ml/s. The IPSS scores should be more than 8. Based on the operative time, two groups (<60 min and ≥60 min) were classified. Results We developed the endoscopic surveillance system which is original in the world. In vitro trials, the average irrigating fluid were (100.60±2.07) ml, (201.00±3.39) ml, (302.00±4.67) ml, (403.60±4.39) ml and (502.40±7.57) ml; and the average bleeding were (5.06±0.11) ml, (10.10±0.16) ml, (15.04±0.15) ml, (20.06±0.11)ml and (25.10±0.16) ml. No significant difference was observed in all groups (P>0.05). In clinical trials, we compared some preoperative and postoperative indexes. The average blood oxygen saturation were (94.46±2.49)% and (92.39±2.77)%(P 0.05). The MAP were (90.32±9.75)mmHg and (91.07±8.96)mmHg(P>0.05). The average serum potassium ion concentration were (4.13±0.53)mmol/L and (4.09±0.37)mmol/L(P>0.05). The average irrigating fluid absorption of the group less than 60 minutes and the group equal or more than 60 minutes were (401.83±279.23)ml and (885.25±367.68)ml(P<0.01). The average blood loss were (64.10±47.47)ml and (158.40±65.22)ml(P<0.01). The preoperative and postoperative hemodynamic, blood biochemical and hematology showed difference in our trials. Irrigating fluid absorption and blood loss were positively associated with operation time. Conclusions The endoscopic surveillance system was safety and accuracy. It can offer real-time monitoring data and alarm mechanism for the surgeons that possibly improve operation safety. Key words: Endoscopic surveillance system; Irrigating fluid absorption; Bleeding; Transurethral resection of the prostate

A simple fluid dynamic model of renal pelvis pressures during ureteroscopic kidney stone treatment.

Ureteroscopy is an endoscopic kidney stone removal procedure which increases the internal pressure in the renal pelvis, the kidney’s urinary collecting system. Elevated renal pelvic pressure may result in systemic absorption of irrigation fluid and urine, which can increase the risk of postoperative fever and sepsis. Urologists have investigated the effects of various surgical parameters on the renal pelvic pressure. However, it still remains unknown which surgical parameter has the most dominant effect on the renal pelvic pressure over time. Here we develop a physical model that computes the renal pelvic pressure as a function of time based on parameters that can be varied during ureteroscopy. The model is developed by applying pipe network analysis to the regions of the urinary tract that are involved in a representative ureteroscopic procedure. Our model unifies the findings of the previously published studies on this topic; an ex-vivo porcine study and an in-vivo human study. Furthermore it allows simulation of surgical procedures based on various techniques. Our simulation demonstrates that the two strong regulators of renal pelvis pressure during ureteroscopy are the size of the gap between ureteroscope and ureteral access sheath and the frequency and duration of ureteroscope withdrawal.

Observation of anterior chamber volume after cataract surgery with swept-source optical coherence tomography.

To investigate the changes in the anterior chamber volume (ACV) with swept-source optical coherence tomography (SS-OCT) after cataract surgery and the factors that influence these ACV changes. This was a prospective cohort study. Fifty-one patients who underwent cataract surgery were enrolled. Their ACV, anterior chamber depth, and angle widths were measured with SS-OCT before and 1day, 1week, and 1month after surgery. The associations between the changes in ACV and posterior vitreous detachment (PVD) and axial length (AXL) were determined. Compared with the preoperative volume, ACV increased significantly at all three time points after surgery (all p < 0.001). ACV was greater at 1week after surgery than at 1day after surgery (p < 0.001). Both AXL and the presence of PVD were significantly associated with the change in ACV at 1day after surgery (p = 0.005). However, neither PVD nor AXL affected the change in ACV between 1day and 1week after surgery. ACV stabilized in the first week after cataract surgery. The absorption of irrigation fluid and balanced salt solution in the vitreous cavity contributed to the change in ACV 1week after surgery. Eyes with longer AXL and PVD tended to show less change in ACV at 1day after surgery.