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

原文:2022年 发布于 World J Urol 40卷 第3期 697-708 浏览量:312次 原文链接

作者: Ortner G. Nagele U. Herrmann T. R. W. et al

作者单位: Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria. gernot.ortner@tirol-kliniken.at. Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland.

归属分类: 良性前列腺增生治疗及预后证据

DOI: 10.1007/s00345-021-03769-4

关键词: Bipolar Fluid absorption Laser PVP TUR TUR-syndrome Transurethral surgery

文献简介

PURPOSE: 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. METHODS: 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. RESULTS: Mean and maximum IFA during bTURP ranges between 133 and 915 ml and 1019 ml and 2166 ml, respectively. Absorption during laser procedures can be significant with maximum values up to 4579 ml and mainly occurs during prostate vaporization techniques. Incidence of moderate to severe symptoms from iso-osmolar volume overload reaches 9%. CONCLUSIONS: 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.

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