Irrigation Fluid Research Articles

Intraprostatic Injection of Tranexamic Acid Decrease Blood Loss During Monopolar Transurethral Resection of the Prostate: A Randomized Controlled Clinical Trial

ObjectiveTo assess the role of intraprostatic injection of tranexamic acid (TXA) in reducing blood loss during transurethral resection of the prostate (TURP). MethodsWe conducted a randomized, controlled, double-blind trial involving 60 patients with benign prostatic hyperplasia (BPH) aged 50–85 years, undergoing monopolar TURP. Patients' prostatic weights ranged from 50 to 80 grams. They were divided equally into two groups: Group I received an intraprostatic injection of 1 gram of TXA (Cyklokapron) dissolved in 50 ml of 0.9% saline at multiple sites, while Group II (control) received a 60 ml saline injection. Comprehensive clinical assessments and standard laboratory tests, including screenings for TXA hypersensitivity, were performed for all patients. ResultsGroup I exhibited significantly lower intraoperative blood loss and hemoglobin concentration in irrigation fluid immediately post-surgery and at the 6-hour postoperative mark compared to Group II (P < 0.05). Coagulation parameters—activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen level (FB), and thrombin clotting time (TT)—showed no significant differences between the groups preoperatively or at 6 and 24 hours postoperatively. No thromboembolic events or other complications were reported in either group. ConclusionThe intraprostatic injection of TXA during monopolar TURP is safe, with minimal adverse effects, and effectively reduces blood loss.

The Effect of Laser Settings and Ureteral Access Sheath Size on Intrapelvic Temperature during Holmium Laser Lithotripsy

Introduction: Thermal damage to the kidney during holmium laser lithotripsy is a serious complication, which cannot always be prevented considering the diversity of conditions in the kidney and the lack of technical capability to measure intrarenal temperature in real-time. The aim of this study was to analyze the impact of different power settings of the holmium laser and the flow rate of irrigation fluid conditioned by the size of the sheath on the fluid temperature in a model of the pelvicalyceal system during lithotripsy. Materials and Methods: A lithotripsy of artificial stones was performed in a 3D-printed model of the renal pelvicalyceal system with a volume of 20.5 mL. A gravity-driven fluid flow was applied (p = 60 cm H2O). A 9.2Fr ureteroscope was introduced into the model through a ureteral access sheath of either 10/12Fr or 12/14Fr. Lithotripsy power ranged from 12 to 25 W. Temperature was measured using thermography. Results: For the 10/12Fr ureteral access sheath, the fluid flow rate was 2.7 mL/min, with the maximum temperature reached within 20 min ranging from 45 to 50 °C. For the 12/14Fr ureteral access sheath, the fluid flow rate was 9.8 mL/min, with the achieved temperature ranging from 35 to 45 °C. Laser power influenced the rate of temperature increase and the maximum temperature reached. During the first 5 min, the rate of temperature increase was solely dependent on laser power, not on the flow rate. Temperatures of 40 °C were only not exceeded with high flow rates (12/14Fr sheath) and power below 20 W. Conclusions: In a short period, the rate of temperature increase depends solely on laser power, not on the irrigation flow rate. During prolonged lithotripsy, the maximum temperature value depends on both parameters.

Response of Articular Cartilage to Hyperosmolar Stress: Report of an Ex Vivo Injury Model

Background: Physiological 0.9% saline is commonly used as an irrigation fluid in modern arthroscopy. There is a growing body of evidence that a hyperosmolar saline solution has chondroprotective effects, especially if iatrogenic injury occurs. Purpose: To (1) corroborate the superiority of a hyperosmolar saline solution regarding chondrocyte survival after mechanical injury and (2) observe the modulatory response of articular cartilage to osmotic stress and injury. Study Design: Controlled laboratory study. Methods: Osteochondral explants were isolated from bovine stifle joints and exposed to either 0.9% saline (308 mOsm) or hyperosmolar saline (600 mOsm) and then damaged with a sharp dermatome blade to attain a confined full-thickness cartilage injury site, incubated in the same fluids for another 3 hours, and transferred to chondropermissive medium for further culture for 1 week. Chondrocyte survival was assessed by confocal imaging, while the cellular response was evaluated over 1 week by relative gene expression for apoptotic and inflammatory markers and mediator release into the medium. Results: The full-thickness cartilage cut resulted in a confined zone of cell death that mainly affected superficial zone chondrocytes. Injured samples that were exposed to hyperosmolar saline showed less expansion of cell death in both the axial (P < .007) and the coronal (P < .004) plane. There was no progression of cell death during the following week of culture. Histological assessment revealed an intact cartilage matrix and normal chondrocyte morphology. Inflammatory and proapoptotic genes were upregulated on the first days postexposure with a notable downregulation toward day 7. Mediator release into the medium was concentrated on day 3. Conclusion: This in vitro cartilage injury model provides further evidence for the chondroprotective effect of a hyperosmolar saline irrigation fluid, as well as novel data on the capability of articular cartilage to quickly regain joint homeostasis after osmotic stress and injury. Clinical Relevance: Raising the osmolarity of an irrigating solution may be a simple and safe strategy to protect articular cartilage during arthroscopic surgery.

257 Breaking the Mold: An International, Multicenter Study on Active and Continuous Irrigation With Cerebrospinal Fluid Exchange for Improving Outcomes in Cerebral Ventriculitis

INTRODUCTION: Cerebral ventriculitis remains one of the most challenging neurosurgical conditions, with poor outcome and a long course of treatment and duration of hospital stay. Despite the current conventional management plans, i.e., using antibiotics in addition to CSF drainage, the outcome remains unsatisfactory in some cases, with no definitive therapeutic guidelines. METHODS: We conducted a multicenter, international, retrospective study of ventriculitis patients treated with a novel automated active irrigation, and drainage system. Data collected included patients’ demographics, comorbidities, admission Glasgow Coma Scale (GCS) score, and pre-hospital modified Rankin Scale (mRS). Catheter occlusions, infections, and shunt placement was recorded for outcome assessment, along with discharge mRS, and in-hospital mortality. RESULTS: Four centers (3 from U.S and 1 from Finland) contributed data for a total of 21 ventriculitis patients who had IRRAflow placement. Thirteen (61.9%) were males (mean age = 49.8 ± 14.87 years). The baseline median mRS was 1 and the median GCS at time of ventriculitis diagnosis was 13. Etiology of ventriculitis was iatrogenic in 12 (57.4%), and secondary to abscess in 9 (42.6%). No cases reported hemorrhage, or failure of IRRAflow placement. Antibiotics were administered in through the IRRAflow in 13 (61.9%) cases in addition to systemic dosing. Sixteen (76.19%) patients had significant clinical improvement and resolution of ventriculitis. Seven (33.33%) patients required shunt placement after resolution. There were 6 (28.6%) in-hospital mortalities reported. CONCLUSIONS: Use of active and continuous irrigation with drainage for continuous delivery of intraventricular irrigation fluid with antibiotics led to dramatically lower mortality when compared to literature (mortality approx. 70%). In our case series, it led to marked improvement in neurologic status, imaging findings, and CSF profiles making it technically feasible and safe treatment for ventriculitis.

Safety and efficacy of magnesium-rich artificial cerebrospinal fluid for subarachnoid hemorrhage.

This study aimed to investigate the efficacy of using a newly formulated magnesium-rich artificial cerebrospinal fluid (MACSF) as an alternative to normal saline (NS) for intraoperative irrigation during aneurysm clipping in improving the prognosis of patients with Aneurysmal subarachnoid hemorrhage (aSAH). Patients with aSAH who underwent intraoperative irrigation with MACSF or NS during the clipping in the First Affiliated Hospital of Xi 'an Jiaotong University from March 2019 to March 2022 were selected as MACSF group and NS group, respectively. The primary prognostic indicators were the incidence of favorable outcomes (mRS 0-2). The secondary outcome measures included cerebral vasospasm (CVS), mortality, total hospital stay, and intensive care unit (ICU) stay. Safety was evaluated based on the occurrence rates of hypermagnesemia, meningitis, and hydrocephalus. Overall, 34 and 37 patients were enrolled in the MACSF and NS groups, respectively. At 90 days after aSAH onset, the proportion of favorable prognosis in the MACSF group was significantly higher than that in the NS group (p = 0.035). The incidence of CVS within 14 days after surgery was significantly lower in the MACSF group than that in the NS group (p = 0.026). The mortality rate in the MACSF group was significantly lower than in the NS group (p = 0.048). The median lengths of hospital stay (p = 0.008) and ICU stay (p = 0.018) were significantly shorter in the MACSF group than in the NS group. No significant differences were observed in safety measures. Using MACSF as an irrigation fluid for aneurysm clipping can significantly improve the 90-day prognosis of patients with aSAH, which may be related to the reduced incidence of CVS. https://www.clinicaltrials.gov, identifier NCT04358445.

Bilateral Single-session PCNL with Minimally Invasive Technique in Pediatric Nephrolithiasis.

To assess outcomes of bilateral single-session percutaneous nephrolithotomy (PCNL) with minimally invasive techniques in pediatric population. From August 2015 to July 2021, 45 children (including 12 infants) were treated with bilateral single-session PCNL, which included miniPCNL (12-16-Fr) and Microperc (4.8-Fr). Patient, stone and operation-related characteristics, stone-free rate (SFR) and complication rate (CR) were compared using ANOVA. Independent predictors were determined using multivariate linear regression. The mean stone burden was 3.2 cm in sum diameter for both kidneys. For bilateral kidneys, the mean operative time was 61.6min and SFR was 93.3%; CR was 53.3%, of which complications of Clavien grade 1 and 2 accounted for 46.7%. Bilateral Microperc, bilateral miniPCNL and Microperc plus miniPCNL was performed in 19, 14 and 12 children respectively. Both irrigation volume and postoperative stay were less in groups with Microperc. Both SFRs and CRs were satisfactory for the three groups. Self-limiting hematuria represented the most common complication of all cases (33.3%), especially in groups with miniPCNL. The stone burden was the only independent predictor for operative time (P < .001) and the postoperative complication (P = .008). Children with older age (P = .009), higher body mass index (P = .016) or a higher stone burden (P < .001) received larger irrigated fluid volume. Microperc was associated with less irrigated fluid volume (P = .001). Children with Clavien grade 3 complications (P = .004) spent prolonged postoperative hospital stay. With favourable SFR and acceptable CR, bilateral single-session PCNL with minimally invasive techniques might be an effective and safe procedure for pediatric nephrolithiasis.

Exploration of the method and efficacy of treatments for intractable pelvic pain caused by rectal or bladder fistula

Objective: To explore the causes and therapeutic effects of pelvic pain caused by rectal fistula or bladder fistula after comprehensive treatment of cervical cancer and rectal cancer (radiotherapy, surgery, chemotherapy, and other treatments). Methods: A retrospective analysis was conducted on the clinical and pathological data of patients with pelvic tumors admitted to the First People's Hospital of Yinchuan City, Ningxia and the Affiliated Cancer Hospital of Zhengzhou University from June 2016 to June 2022. The causes of persistent pelvic pain in patients after comprehensive treatment was investigated, and the corresponding therapeutic effects after clinical treatment was observed. Results: Thirty-two tumor patients experienced persistent pain after comprehensive treatment, including 22 cases of cervical cancer and 10 cases of rectal cancer. The preoperative pain of the entire group of patients was evaluated using the digital grading method, with a pain score of (7.88±1.31) points. Among the 32 patients, there were 16 cases of rectovaginal fistula or ileovaginal fistula, 9 cases of vesicovaginal fistula, 5 cases of rectoperineal fistula, and 2 cases of vesicovaginorectal fistula. Thirty-two patients were initially treated with medication to relieve pain, and according to the ruptured organs, a fistula was made to the corresponding proximal intestinal canal and renal pelvis to intercept the intestinal contents and urine. However, the pain did not significantly be improved. The pain score of treatment with the above methods for one week was (8.13±1.13) points, and there was no statistically significant difference compared to preoperative treatment (P=0.417). In the later stage, based on a comprehensive evaluation of whether the tumor had recurred, the value of organ preservation, the benefits of surgery, the balance between survival time and improving quality of life, pathological organ resection or repair was performed. The surgical methods included repair of leaks, local debridement combined with irrigation of proximal intestinal fluid, distal closure of the sigmoid colon combined with proximal ostomy, posterior pelvic organ resection, anterior pelvic organ resection, and total pelvic organ resection. One week after surgery, the patients' pain completely relieved or disappeared, with the pain score of (1.72±1.37) points, which was significantly divergent from the preoperative and initial surgical treatments (P＜0.001). Conclusions: Palliative pyelostomy and proximal enterostomy cannot effectively alleviate persistent pelvic floor pain. The fundamental way to alleviate pain is complete blocking of the inflammatory erosion of the intestinal fluid and urine.

First in-human clinical performance of a new non-cavitating handheld lensectomy system in 665 consecutive cataract surgeries.

To investigate the intraoperative performance and lens fragmentation efficacy of a non-cavitating handheld lensectomy system in mild, moderate, and severe cataract. Ambulatory surgical centers. Retrospective consecutive case series. 665 consecutive eyes underwent cataract surgery by 12 surgeons using a new handheld non-cavitating lensectomy system for nuclear fragmentations and extraction. Intraoperative measurements included surgical time, miLOOP pretreatment, and irrigation fluid use. Of the 665 eyes, 38 (6%), 468 (70%), 126 (19%), and 33 (5%) were of grade 1, 2, 3, and 4 nuclear densities, respectively, as graded by the surgeon intraoperatively. Successful nuclear fragmentation, lens extraction, and cortical removal were achieved in all eyes. Total nucleus fragmentation and extraction times were 70.1 seconds, 100.3 seconds, 132.6 seconds, and 287.9 seconds for grades 1, 2, 3, and 4, respectively ( P < .001). In addition, irrigation and aspiration cortical removal times were 64.1 seconds, 51.1 seconds, 48.5 seconds, and 59.0 seconds, respectively ( P = .14). There was a low rate of capsular tear (3 cases in 665 surgeries, 0.45%) and no other emergent adverse events. The miCOR handheld non-cavitating lensectomy system demonstrated nuclear fragmentation and extraction in the absence of intraocular cavitation across all grades of nuclear densities.

The Effect of Warmed Irrigation and Intravenous Fluids on Body Temperature During Photo-Selective Vaporization of the Prostate

Introduction: A significant number of men with benign prostatic hyperplasia (BPH) will require surgical therapy. The technique of photoselective vaporization of the prostate (PVP), using the Greenlight laser™, is one of the most employed procedures to treat BPH. A frequent complication among patients undergoing surgery is intraoperative hypothermia (body temperature &lt; 36.0°C). The aim of the current study was to determine if warming the irrigation and the intravenous (IV) fluids can mitigate hypothermia during PVP surgery

Study on the therapeutic mechanism of HJ granules in a rat model of urinary tract infection caused by Escherichia coli

Ethnopharmacological relevanceUrinary tract infections (UTIs) are globally prevalent infectious diseases, predominantly caused by uropathogenic Escherichia coli (UPEC). The misuse of antibiotics has led to the emergence of several drug-resistant strains. Traditional Chinese Medicine (TCM) has its own advantages in the treatment of UTIs. HJ granules is a herbal formula used for the treatment of UTIs. However, its mechanism of action is not clear. Aim of the studyThe aim of this study was to investigate the therapeutic efficacy and mechanism of action of HJ granules in a rat model of UTI caused by Escherichia coli (E coli) CFT073. Materials and methodsSD rats were selected to establish a rat UTI model by injecting UPEC strain CFT073 into the bladder using the transurethral placement method. HJ granules were administered to rats after modelling and the efficacy of HJ granule was investigated by measuring urinary decanalogue, inflammatory factors in bladder tissue and pathological changes in the bladder after 3d of administration. Expression of sonic hedgehog (SHH), NOD-like receptor thermoprotein domain 3 (NLRP3), apoptosis-associated speck-like protein (ASC) and activation of cysteinyl aspartate specific proteinase-1 (caspase-1) were detected by western blotting and immunofluorescence staining in rat bladder tissue. NLRP3, ASC and caspase-1, a cysteine-containing aspartic protein, were expressed and activated. ResultsThe results showed that infection of rats with UPEC resulted in increased pH and erythrocytes in bladder irrigation fluid; increased expression of IL-1β, IL-6 and SHH and decreased expression of IL-10 in bladder tissue; and significant upregulation of the expression of both SHH and NLRP3 inflammasom and significant activation of NLRP3 inflammasom. HJ granules significantly increased the concentration of IL-10 in the bladder, inhibited the expression of SHH and NLRP3 inflammasom in bladder tissue, and suppressed the activation of NLRP3 inflammasom, thereby reducing inflammatory lesions in bladder tissue. ConclusionHJ granules may improve bladder injury and treat UTIs by inhibiting the expression and activation of NLRP3 inflammasom.

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.

Sterile Water Versus Glycine in Transurethral Resection of Bladder Tumors—Immunogenic and Clinical Implications

Background and objectiveWe compared the oncologic outcomes of patients with non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TUBRT) using sterile water vs glycine irrigation. The tumoricidal and immunogenic effects of these solutions on urothelial cancer cell lines were investigated. MethodsThe medical records of 530 consecutive patients who underwent TURBT using sterile water or glycine irrigation for NMIBC were reviewed. Recurrence and progression rates were evaluated using time dependent analyses.Bladder cancer cell lines (RT4, T24 and 5637) were treated with glycine and sterile water. Cell viability was evaluated with the XTT assay. Cell membrane calreticulin levels were evaluated with flow cytometry. Extracellular high mobility group box 1 (HMGB1) and heat shock 70 (HSP70) protein levels were evaluated using western blots. Key findings and limitationsAfter propensity score matching each study arm comprised 161 patients. Median follow-up was 13.6 months (IQR 6.2, 24.5). The 2-year recurrence free survival was significantly lower in the sterile water vs glycine group (43% vs 71%, respectively, p<0.0001). Similarly, the 2-years progression free survival was significantly lower in the sterile water vs glycine group (85% vs 94%, respectively, p<0.014). Sterile water treatment resulted in the lowest number of viable cells. Early and late immunogenic cell death markers were markedly elevated in cells treated with glycine. Conclusions and clinical implicationsSterile water compared to glycine irrigation during TURBT for NMIBC was associated with higher recurrence and progression rates. Possible explanation for these findings is the diminished immune response associated with sterile water reflected in a comparatively lesser expression of immune response inducers. Patient summaryWe compared two irrigation fluids in non–muscle-invasive bladder cancer surgery: glycine and sterile water. Glycine outperformed sterile water in cancer recurrence, possibly boosting immunogenicity over sterile water.

Does Autologous Blood Injection Following Dextranomer/Hyaluronic Acid Copolymer Implantation in Treating Vesicoureteral Reflux Affect the Microsphere Particle Leakage?

Objectives: It has been shown that concomitant autologous blood and dextranomer/hyaluronic acid (Deflux®) injection, hydrodistension autologous blood injection technique (HABIT), had a better mound preservation and treatment success compared to the hydrodistension injection technique (HIT) in vesicoureteral reflux (VUR) correction. In this study, we aimed to show microscopically whether the concomitant injection of autologous blood decreases the leakage of Deflux® particles. Methods: Children with VUR who underwent HIT or HABIT between March 2020 and January 2023 were enrolled. Following the completion of the procedure on each ureter, the bladder was irrigated for 3 to 5 min, and the retrieved sample of irrigation fluid was evaluated for dextranomer particle count as “immediate leakage”. A Foley catheter was placed, and a urine sample after 12 h was collected as “early leakage”. Results: A total of 86 children with a median age of 3.0 years (interquartile range = 4.6) were included. Overall, 66 patients underwent HABIT, and 20 children underwent HIT. Rupture was observed in five patients during the procedure, and re-injection was conducted successfully in these cases. Immediate, early, and total particle leakage in the first 12 h of the injection were significantly less in the HABIT group compared to the HIT group. In the regression analysis, only the injection technique (HIT/HABIT) and rupture were significantly associated with the total particle leakage in the first 12 h. Conclusions: Immediate injection of autologous blood into the mound following an endoscopic correction of VUR in children is associated with significantly less Deflux® particle leakage from the injection site regardless of the VUR grade. We hypothesize that a concomitant blood injection into the Deflux® mound will create a blood clot while the needle is kept in situ and help to stabilize the mound and decrease treatment failure by minimizing particle leakage from the injection site.

Spinal Anestesi Pada Tindakan Transuretral Resection Of Prostat (TURP)

Spinal anesthesia is the choice for Transurethral Resection of Prostate (TURP) procedures. TURP is a surgical procedure performed for patients with prostatic hyperplasia. When a TURP procedure is performed, excessive fluid absorption will occur because during the procedure the injured area causes the vein to open and irrigation fluid will be absorbed. The position of the surgical procedure in the lithotomy position makes the situation worse. Spinal anesthesia helps peripheral blood collection and reduces circulatory overload, early detection of TURP syndrome and bladder perforation. In this case, the procedure was carried out on a 67 year old man with a diagnosis of benign prostate hyperplasia (BPH) with a TURP surgical procedure. The patient was composmentis, ASA III. The patient underwent spinal anesthesia with a sub arachnoid block using Bupivacaine. During TURP procedures, TURP syndrome can occur which is influenced by the use of fluid as irrigation to widen the operator's field of view. Saline fluid should be used, but because it is expensive, H2O is often used as irrigation fluid. A complication of the TURP procedure is TURP syndrome

Does the drainage of irrigation through the ureteral access sheath have an impact on the results of primary retrograde intrarenal surgery?

Purpose: One of the risk factors associated with post-operative fever and infections is the amount of fluid absorbed by the kidney. We conducted a prospective study to analyse the effects of irrigation fluid inflow and outflow on post-operative complications and stone-free rate. Material and methods: We did a prospective study on all primary retrograde intrarenal surgery (RIRS) cases performed at our hospital between JAN 2020 and JAN 2023. The fluid draining out of the access sheath was collected in a measuring container until the flexible scope was inside the access sheath. The amount of fluid retained by the body was measured by calculating the difference between the quantity of irrigation fluid utilised and the output from the access sheath. Results: A total of 566 patients were included in the study. The retained volume of more than 100 ml was associated with more pain (0.0/426 vs 49/140, p &lt; 0.001), a higher incidence of fever (7/426 vs 22/140, p &lt; 0.001), a higher incidence of high-grade complications (G4A 0 vs 4), and a higher incidence of residual stones (11/426 vs 49/140, p &lt; 0.001). Conclusion: The outflow from the access sheath is a crucial factor that can significantly impact the outcome of RIRS. Level of evidence: Not applicable

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

ObjectiveTo investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intra-operative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study. MethodsOne hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. The prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared. ResultsA total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury. ConclusionIntra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

Changes in endothelial cell density after conventional phacoemulsification and FLACS in eyes with dense cataracts.

To compare the safety, effectiveness, and changes in endothelial cell density (ECD) after standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (Lens Opacities Classification System III grade 3.0 NO and above). Nethradhama Superspeciality Eye Hospital, Bangalore, India. Prospective, randomized, comparative study. 100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using predefined patterns of nuclear fragmentations. Measured outcomes included intraoperative phacoemulsification time, irrigation fluid volume, surgical time, and complication rates. ECD was evaluated at baseline, 2 weeks, and 6 months postoperatively. The CPS group had significantly higher mean total phacoemulsification time (11.17 ± 6.5 seconds vs 8.03 ± 3.77 seconds), effective phacoemulsification time (6.14 ± 3.62 seconds vs 4.42 ± 2.07 seconds), and total surgical time (8.18 ± 2.36 minutes vs 7.11 ± 1.55 minutes) than the FLACS group ( P < .001). Volume of irrigation fluid was comparable between the 2 groups (CPS, 36.7 ± 12.18 mL; FLACS, 38.64 ± 13.73 mL ( P = .45). Mean corneal edema score and central corneal thickness values on postoperative day 1 were significantly higher for the CPS group. At 6 months, % ECD loss was significantly higher in the CPS group (16.08%) vs the FLACS group (12.8%) ( P < .001). 3 eyes in the CPS group had wound burns of varying severity. FLACS with customized nuclear fragmentation patterns resulted in significantly less intraoperative phacoemulsification time, surgical time, and endothelial cell loss compared with conventional phacoemulsification when treating dense cataracts. CTRI/2021/12/038887.

A narrative review of current and future of Unilateral Biportal Endoscopic (UBE) transforaminal lumbar interbody fusion

With the ongoing development of Unilateral Biportal Endoscopic (UBE) spine surgery, it has become standard of care at many centers across the globe for lumbar decompressions and discectomies due to minimal muscle damage, minimal postoperative back pain and early recovery. In UBE, the separation of viewing portal and working portal allows greater freedom of movement for the surgical instruments as the camera and instruments move independently providing unrestricted vision. Moreover, the continuous irrigation fluid pressure decreases bleeding and helps to irrigate out the bone debris. Hence, UBE spine surgery has become quite popular and has expanded its indications to lumbar spinal fusion. The adoption of UBE for conventional spine surgeons into their routine practice is relatively easier than uniportal endoscopy because of use of standard arthroscopic lenses, familiar view of anatomy, and use of conventional open spinal instruments. In this article, we review the current literature and discuss the indications, contraindications, clinical outcomes, complications and compare it with existing minimally invasive transforaminal lumbar interbody fusion.

Efficacy of intraoperative irrigation with artificial cerebrospinal fluid in chronic subdural hematoma surgery: study protocol for a multicenter randomized controlled trial

BackgroundThe surgical techniques for treatment of chronic subdural hematoma (CSDH), a common neurosurgical condition, have been discussed in a lot of clinical literature. However, the recurrence proportion after CSDH surgery remains high, ranging from 10 to 20%. The standard surgical procedure for CSDH involves a craniostomy to evacuate the hematoma, but irrigating the hematoma cavity during the procedure is debatable. The authors hypothesized that the choice of irrigation fluid might be a key factor affecting the outcomes of surgery. This multicenter randomized controlled trial aims to investigate whether intraoperative irrigation using artificial cerebrospinal fluid (ACF) followed by the placement of a subdural drain would yield superior results compared to the placement of a subdural drain alone for CSDH.MethodsThe study will be conducted across 19 neurosurgical departments in Japan. The 1186 eligible patients will be randomly allocated to two groups: irrigation using ACF or not. In either group, a subdural drain is to be placed for at least 12 h postoperatively. Similar to what was done in previous studies, we set the proportion of patients that meet the criteria for ipsilateral reoperation at 7% in the irrigation group and 12% in the non-irrigation group. The primary endpoint is the proportion of patients who meet the criteria for ipsilateral reoperation within 6 months of surgery (clinical worsening of symptoms and increased hematoma on imaging compared with the postoperative state). The secondary endpoints are the proportion of reoperations within 6 months, the proportion being stratified by preoperative hematoma architecture by computed tomography (CT) scan, neurological symptoms, patient condition, mortality at 6 months, complications associated with surgery, length of hospital stay from surgery to discharge, and time of the surgical procedure.DiscussionWe present the study protocol for a multicenter randomized controlled trial to investigate our hypothesis that intraoperative irrigation with ACF reduces the recurrence proportion after the removal of chronic subdural hematomas compared with no irrigation.Trial registrationClinicalTrials.gov jRCT1041220124. Registered on January 13, 2023.

Endoscopic Cylinder Surgery for Ventricular Lesions.

Cylinder retractors have been developed to reduce the risk of brain retraction injury during surgery by dispersing retraction pressure on the brain. In recent years, various types of cylinder retractors have been developed and widely used in neurosurgery. The ventricles, being deep structures within the brain, present an effective area for cylinder retractor utilization. Endoscopy provides a bright, wide field of view in the deep surgical field, even through narrow corridors.This chapter introduces surgical techniques using an endoscope through a cylinder. Given the deep and complex shapes of the ventricles, preoperative planning is paramount. Two main surgical techniques are employed in endoscopic cylinder surgery. The wet-field technique involves the continuous irrigation of artificial cerebrospinal fluid (CSF) during the procedure, maintaining ventricle shape with natural water pressure, facilitating tumor border identification, and achieving spontaneous hemostasis. Conversely, the dry-field technique involves CSF drainage, providing a clear visual field even during hemorrhage encounters. In intraventricular surgery, both techniques are used and switched as needed.Specific approaches for lateral, third, and fourth ventricular tumors are discussed, considering their locations and surrounding anatomical structures. Detailed intraoperative findings and strategies for tumor removal and hemostasis are presented.Endoscopic cylinder surgery offers a versatile and minimally invasive option for intraventricular tumors, leading to improved surgical outcomes. Overall, this technique enhances surgical precision and patient outcomes in intraventricular tumor cases.