Original ContributionsTransurethral resection syndrome: effect of the introduction into clinical practice of a new method for monitoring fluid absorption
Introduction
Endoscopic transurethral resection of the prostate (TURP) is a commonly used surgical procedure to treat benign or cancerous enlargements of the prostate. One side effect is known as transurethral resection (TUR) syndrome, a condition caused by excessive absorption of hypotonic bladder irrigating fluid.
Excessive absorption of irrigating solution leads to fluid overload and dilution of plasma electrolytes and clotting factors. The resulting hyponatremia and hypervolemia can cause major morbidity and mortality.1 Several methods have been proposed to quantify the amount of systemic irrigating fluid absorption; these include measuring the inflow and outflow volumes, body weight, measuring serial plasma concentrations of glucose, mannitol, sorbitol, and glycine, and using radioisotopes in the irrigating solution.2, 3 In 1986, adding alcohol to the irrigating fluid and measuring end-tidal alcohol concentration was proposed as a routine monitoring method.4 Considering that absorption volumes in excess of 1000 ml are common, irrigating solutions containing 1% and 2% alcohol can have systemic side effects, with sensorial disturbances.5, 6 Alcohol intoxication can make it difficult to recognize the central nervous sign of hyponatremia.4, 7 Thus, the aim of this study was to examine: (1) the utility of a 0.5% alcohol-containing irrigating solution to detect small amounts of fluid absorption and (2) the possible reduction of fluid absorption when monitoring the absorption by an alcohol irrigating solution using statistical methods of process control.
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Materials and methods
A 0.5% alcohol and 4% glucose containing electrolyte-free irrigating solution was used in 312 consecutive male patients undergoing TURP. The Kantonsspital Ethics Committee approved the change of practice, and each patient gave verbal informed consent to undergo the procedure.
End-tidal alcohol concentrations were determined at 10-minute intervals during surgery. A portable electrochemical alcohol analyzer (Alcomed 3010, Biotest Co., Frankfurt, Germany) was used to measure ethanol concentrations.
Results
Demographic data of the patient population are summarized in Table 1. End-tidal alcohol concentrations were observed in 47.8% of all the patients, indicating fluid absorption. When absorption occurred, maximum values typically were recorded 30 to 40 minutes after the start of surgery (Figure 1). Sudden peak concentrations due to the direct IV route (periprostatic veins) were observed in single cases. Figure 1 demonstrates the time course of prevalence of absorption. The mean absorbed volume
Discussion
Measurement of the extent of systemic fluid uptake in TURP by marking the irrigating solution with alcohol and measuring end-tidal alcohol concentration was introduced into clinical practice in 1986.4 Initially, we also used 2% alcohol-containing irrigating solution. Because the use of the breath analyzer was somewhat cumbersome, it was not accepted by our staff for routine clinical application. With the advent of a more sensitive analyzer that was easy to use (Alcomed 3010, Biotest Co.,
Acknowledgements
We would like to thank Beat Kaiser, CRNA, Lucerne, for his enthusiasm and help performing this investigation, and Rom Stevens, MD, Chicago, for editorial assistance.
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Bipolar versus monopolar transurethral resection of the prostate: A prospective randomized trial focusing on bleeding complications
2015, Journal of UrologyCitation Excerpt :Both irrigating solutions contained 1% ethanol, and intraoperative fluid absorption during M-TURP and B-TURP was monitored every 10 minutes by concurrent measurement of expiratory alcohol levels using an Alcomed 3010 alcometer (Biotest Co., Frankfurt, Germany). The absorbed irrigation fluid was calculated using the Widmark formula.10 An expiratory alcohol concentration between 0.01% and 0.2% means a fluid absorption of 50 to 1,000 ml, an expiratory alcohol concentration between 0.2% and 0.4% means a fluid absorption of 1,000 to 2,000 ml, and a fluid absorption greater than 0.4% means a fluid absorption greater than 2,000 ml.
Absorption of Irrigation Fluid Occurs Frequently during High Power 532 nm Laser Vaporization of the Prostate
2015, Journal of UrologyCitation Excerpt :Calculations of fluid absorption from breath ethanol measurements have been optimized by taking different factors into account (ie type of absorption, ethanol metabolism and redistribution) and nomograms have been developed.10 Numerous studies have been performed to quantify fluid absorption and identify risk factors for fluid absorption during conventional TURP.13–16 Barber et al were the first to investigate fluid absorption during 532 nm LV of the prostate using the breath ethanol test.7
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2006, British Journal of AnaesthesiaCitation Excerpt :Fluid absorption varies between surgeons and depends on their skill in avoiding prostatic capsule perforations and the opening up of venous sinuses. However, studies do not support that experienced surgeons have less fluid absorption during their operations6174 but those who obtain immediate feedback via ethanol monitoring learn how to operate with less fluid absorption.74 Spinal anaesthesia does not reduce absorption48 but allows early detection of gross changes in mental status.