Abstract
Purpose
To assess whether and to what extent irrigation fluid absorption occurs during laser vaporization (LV) of the prostate using the 180 W XPS™ GreenLight laser.
Methods
This prospective investigation was performed in a tertiary care center with a consecutive series of patients undergoing 180 W LV of the prostate. Intraoperative irrigation was performed with isotonic saline containing 1 % ethanol. The volume of irrigation fluid absorption was calculated from periodically performed breath ethanol measurements during LV. Additionally, intraoperative changes in biochemical and hematological blood parameters were assessed.
Results
Positive breath ethanol tests were detectable in 22 of 54 patients. The median absorption volume in these patients was 950 ml (range 208–4579 ml). Ten patients absorbed more than 2000 ml. Absorbers had smaller prostates, more capsular perforations and injuries to venous sinuses, and more total energy was applied with higher output power. Five patients had transient symptoms potentially related to fluid absorption. A significant drop in hemoglobin, hematocrit, venous pH and bicarbonate and an increase in chloride were detectable in the absorber group. These changes were significantly different in the non-absorber group.
Conclusions
Absorption of irrigation fluid did occur in a relevant proportion of patients undergoing XPS™ GreenLight LV. High-volume absorption (≥2000 ml), which might be clinically relevant, was detectable in almost 20 % of all procedures. Absorption of saline irrigation fluid does not result in a classical TUR syndrome, but fluid and chloride overload can lead to serious complications, particularly in cardiovascular high-risk patients. Thus, patients with symptoms potentially related to fluid absorption should be monitored carefully.
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Acknowledgments
The authors would like to thank Alexandra Veloudios for the excellent organization of the patient care during this study.
Authors’ contribution
M S. Wettstein, C. Poyet and T. Hermanns were involved in protocol/project development, data collection or management, data analysis and wrote and edited the manuscript. N. C. Grossmann and C. D. Fankhauser were involved in protocol/project development, data collection or management and wrote and edited the manuscript. E. X. Keller, M. Kozomara, S. Meyer, T. Sulser and A. Müller were involved in data collection or management and wrote and edited the manuscript.
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The authors declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee (KEK-ZH-Number: 2010-0527/4).
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Informed consent was obtained from all individual participants included in this study.
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Marian S. Wettstein and Cédric Poyet have contributed equally to this work.
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Wettstein, M.S., Poyet, C., Grossmann, N.C. et al. Absorption of irrigation fluid during XPS™ GreenLight laser vaporization of the prostate: results from a prospective breath ethanol monitoring study. World J Urol 34, 1261–1267 (2016). https://doi.org/10.1007/s00345-016-1766-x
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DOI: https://doi.org/10.1007/s00345-016-1766-x