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

World Journal of Urology volume 40, pages 697–708 (2022)Cite this article

Abstract

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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Fig. 1

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Authors and Affiliations

  1. Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria

    Gernot Ortner, Udo Nagele & Theodoros Tokas

  2. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

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  1. Gernot Ortner
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  2. Udo Nagele
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  3. Thomas R. W. Herrmann
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  4. Theodoros Tokas
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GO—data collection, data analysis and manuscript writing. UN—critical review and data interpretation. TRWH—critical review and data interpretation. TT—project development, data management and manuscript editing.

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Correspondence to Gernot Ortner.

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All author are members of Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group.

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Ortner, G., Nagele, U., Herrmann, T.R.W. et al. Irrigation fluid absorption during transurethral bipolar and laser prostate surgery: a systematic review. World J Urol 40, 697–708 (2022). https://doi.org/10.1007/s00345-021-03769-4

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