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

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...

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Bibliographic Details
Published in:World journal of urology 2022-03, Vol.40 (3), p.697-708
Main Authors: Ortner, Gernot, Nagele, Udo, Herrmann, Thomas R. W., Tokas, Theodoros
Format: Article
Language:English
Subjects:
Bicarbonates
Enucleation
Ethanol
Humans
Invited Review
Laser Therapy
Lasers
Lavage
Male
Medicine
Medicine & Public Health
Nephrology
Oncology
Prostate
Prostate - surgery
Prostatic Hyperplasia - complications
Surgery
Therapeutic Irrigation - adverse effects
Transurethral Resection of Prostate - methods
Urologic Surgical Procedures
Urology
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Summary: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.
ISSN:1433-8726
0724-4983
1433-8726
DOI:10.1007/s00345-021-03769-4