Skip to main content
Top
Published in: BMC Urology 1/2015

Open Access 01-12-2015 | Study protocol

Is absorption of irrigation fluid a problem in Thulium laser vaporization of the prostate? A prospective investigation using the expired breath ethanol test

Authors: Livio Mordasini, Dominik Abt, Gautier Müllhaupt, Daniel S Engeler, Andreas Lüthi, Hans-Peter Schmid, Christoph Schwab

Published in: BMC Urology | Issue 1/2015

Login to get access

Abstract

Background

Benign prostatic hyperplasia (BPH) is a prevalent entity in elderly men. If medical treatment fails, monopolar transurethral resection of the prostate (TUR-P) is still considered as the standard treatment. The proportion of high-risk patients with cardiac comorbidities increases and TUR-P goes along with a relevant perioperative risk. Especially large volume influx of irrigation fluid and transurethral resection syndrome (TUR syndrome) represent serious threats to these patients. Using isotonic saline as irrigation fluid like in transurethral laser vaporization (TUV-P), TUR syndrome can be prevented. However, no prospective trial has ever assessed occurrence or extent of irrigation fluid absorption in Thulium Laser TUV-P.

Methods/Design

This is a single-center prospective trial, investigating, if absorption of irrigation fluid occurs during Thulium Laser TUV-P by expired breath ethanol test. The expired breath ethanol technique is an established method of investigating intraoperative absorption of irrigation fluid: A tracer amount of ethanol is added to the irrigation fluid and the absorption of irrigation fluid can be calculated by measuring the expiratory ethanol concentrations of the patient with an alcohol breathalyzer.
Fifty consecutive patients undergoing TUV-P at our tertiary referral center are included into the trial. Absorption volume of irrigation fluid during Thulium Laser TUV-P is defined as primary endpoint. Pre- to postoperative changes in bladder diaries, biochemical and hematological laboratory findings, duration of operation and standardized questionnaires are assessed as secondary outcome measures.

Discussion

The aim of this study is to assess the safety of Thulium Laser TUV-P in regard to absorption of irrigation fluid.
Literature
1.
go back to reference Levy A, Samraj GP. Benign prostatic hyperplasia: when to ‘watch and wait’, when and how to treat. Cleve Clin J Med. 2007;74 Suppl 3:S15–20.CrossRefPubMed Levy A, Samraj GP. Benign prostatic hyperplasia: when to ‘watch and wait’, when and how to treat. Cleve Clin J Med. 2007;74 Suppl 3:S15–20.CrossRefPubMed
2.
go back to reference Eckhardt MD, van Venrooij GE, van Melick HH, Boon TA. Prevalence and bothersomeness of lower urinary tract symptoms in benign prostatic hyperplasia and their impact on well-being. J Urol. 2001;166(2):563–8.CrossRefPubMed Eckhardt MD, van Venrooij GE, van Melick HH, Boon TA. Prevalence and bothersomeness of lower urinary tract symptoms in benign prostatic hyperplasia and their impact on well-being. J Urol. 2001;166(2):563–8.CrossRefPubMed
3.
go back to reference Michel MC, Mehlburger L, Bressel HU, Schumacher H, Schafers RF, Goepel M. Tamsulosin treatment of 19,365 patients with lower urinary tract symptoms: does co-morbidity alter tolerability? J Urol. 1998;160(3 Pt 1):784–91.PubMed Michel MC, Mehlburger L, Bressel HU, Schumacher H, Schafers RF, Goepel M. Tamsulosin treatment of 19,365 patients with lower urinary tract symptoms: does co-morbidity alter tolerability? J Urol. 1998;160(3 Pt 1):784–91.PubMed
5.
go back to reference Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Transurethral prostatectomy: immediate and postoperative complications. a cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol 2002. 1989;167(2 Pt 2):999–1003. discussion 1004. Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Transurethral prostatectomy: immediate and postoperative complications. a cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol 2002. 1989;167(2 Pt 2):999–1003. discussion 1004.
6.
go back to reference Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008;180(1):246–9.CrossRefPubMed Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008;180(1):246–9.CrossRefPubMed
7.
go back to reference Hahn RG. The transurethral resection syndrome. Acta Anaesthesiologica Scandinavica. 1991;35(7):557–67.CrossRefPubMed Hahn RG. The transurethral resection syndrome. Acta Anaesthesiologica Scandinavica. 1991;35(7):557–67.CrossRefPubMed
8.
go back to reference Geavlete B, Georgescu D, Multescu R, Stanescu F, Jecu M, Geavlete P. Bipolar plasma vaporization vs monopolar and bipolar TURP-A prospective, randomized, long-term comparison. Urology. 2011;78(4):930–5.CrossRefPubMed Geavlete B, Georgescu D, Multescu R, Stanescu F, Jecu M, Geavlete P. Bipolar plasma vaporization vs monopolar and bipolar TURP-A prospective, randomized, long-term comparison. Urology. 2011;78(4):930–5.CrossRefPubMed
9.
go back to reference Geavlete B, Multescu R, Dragutescu M, Jecu M, Georgescu D, Geavlete P. Transurethral resection (TUR) in saline plasma vaporization of the prostate vs standard TUR of the prostate: ‘the better choice’ in benign prostatic hyperplasia? BJU Int. 2010;106(11):1695–9.CrossRefPubMed Geavlete B, Multescu R, Dragutescu M, Jecu M, Georgescu D, Geavlete P. Transurethral resection (TUR) in saline plasma vaporization of the prostate vs standard TUR of the prostate: ‘the better choice’ in benign prostatic hyperplasia? BJU Int. 2010;106(11):1695–9.CrossRefPubMed
10.
go back to reference Reich O, Schlenker B, Gratzke C, Tilki D, Riecken M, Stief C, et al. Plasma vaporisation of the prostate: initial clinical results. European Urology. 2010;57(4):693–7.CrossRefPubMed Reich O, Schlenker B, Gratzke C, Tilki D, Riecken M, Stief C, et al. Plasma vaporisation of the prostate: initial clinical results. European Urology. 2010;57(4):693–7.CrossRefPubMed
11.
go back to reference Herrmann TR, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. Eau Guidelines Panel on Lasers T: EAU guidelines on laser technologies. European Urology. 2012;61(4):783–95.CrossRefPubMed Herrmann TR, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. Eau Guidelines Panel on Lasers T: EAU guidelines on laser technologies. European Urology. 2012;61(4):783–95.CrossRefPubMed
12.
go back to reference Hermanns T, Fankhauser CD, Hefermehl LJ, Kranzbuhler B, Wong LM, Capol JC, et al. Prospective evaluation of irrigation fluid absorption during pure transurethral bipolar plasma vaporisation of the prostate using expired-breath ethanol measurements. BJU Int. 2013;112(5):647–54.CrossRefPubMed Hermanns T, Fankhauser CD, Hefermehl LJ, Kranzbuhler B, Wong LM, Capol JC, et al. Prospective evaluation of irrigation fluid absorption during pure transurethral bipolar plasma vaporisation of the prostate using expired-breath ethanol measurements. BJU Int. 2013;112(5):647–54.CrossRefPubMed
13.
go back to reference Hermanns T, Grossmann NC, Wettstein MS, Fankhauser CD, Capol JC, Poyet C, et al. Absorption of irrigation fluid occurs frequently during high power 532 nm laser vaporization of the prostate. J Urol. 2015;193:211–6.CrossRefPubMed Hermanns T, Grossmann NC, Wettstein MS, Fankhauser CD, Capol JC, Poyet C, et al. Absorption of irrigation fluid occurs frequently during high power 532 nm laser vaporization of the prostate. J Urol. 2015;193:211–6.CrossRefPubMed
14.
go back to reference Olsson J, Rentzhog L, Hjertberg H, Hahn RG. Reliability of clinical assessment of fluid absorption in transurethral prostatic resection. European Urology. 1993;24(2):262–6.PubMed Olsson J, Rentzhog L, Hjertberg H, Hahn RG. Reliability of clinical assessment of fluid absorption in transurethral prostatic resection. European Urology. 1993;24(2):262–6.PubMed
15.
go back to reference Hahn RG. Ethanol monitoring of irrigating fluid absorption. Eur J Anaesthesiol. 1996;13(2):102–15.CrossRefPubMed Hahn RG. Ethanol monitoring of irrigating fluid absorption. Eur J Anaesthesiol. 1996;13(2):102–15.CrossRefPubMed
16.
go back to reference Bouchier-Hayes DM, Van Appledorn S, Bugeja P, Crowe H, Challacombe B, Costello AJ. A randomized trial of photoselective vaporization of the prostate using the 80-W potassium-titanyl-phosphate laser vs transurethral prostatectomy, with a 1-year follow-up. BJU Int. 2010;105(7):964–9.CrossRefPubMed Bouchier-Hayes DM, Van Appledorn S, Bugeja P, Crowe H, Challacombe B, Costello AJ. A randomized trial of photoselective vaporization of the prostate using the 80-W potassium-titanyl-phosphate laser vs transurethral prostatectomy, with a 1-year follow-up. BJU Int. 2010;105(7):964–9.CrossRefPubMed
17.
go back to reference Pereira-Correia JA, de Moraes Sousa KD, Santos JB, de Morais PD, Lopes-da-Silva LF, Krambeck RL, et al. GreenLight HPS 120-W laser vaporization vs transurethral resection of the prostate (<60 mL): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int. 2012;110(8):1184–9.CrossRefPubMed Pereira-Correia JA, de Moraes Sousa KD, Santos JB, de Morais PD, Lopes-da-Silva LF, Krambeck RL, et al. GreenLight HPS 120-W laser vaporization vs transurethral resection of the prostate (<60 mL): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int. 2012;110(8):1184–9.CrossRefPubMed
18.
go back to reference Al-Ansari A, Younes N, Sampige VP, Al-Rumaihi K, Ghafouri A, Gul T, et al. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. European Urol. 2010;58(3):349–55.CrossRef Al-Ansari A, Younes N, Sampige VP, Al-Rumaihi K, Ghafouri A, Gul T, et al. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. European Urol. 2010;58(3):349–55.CrossRef
19.
go back to reference Capitan C, Blazquez C, Martin MD, Hernandez V, de la Pena E, Llorente C. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up. European Urol. 2011;60(4):734–9.CrossRef Capitan C, Blazquez C, Martin MD, Hernandez V, de la Pena E, Llorente C. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up. European Urol. 2011;60(4):734–9.CrossRef
20.
go back to reference Lukacs B, Loeffler J, Bruyere F, Blanchet P, Gelet A, Coloby P, et al. Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: a multicenter randomized controlled trial. European Urology. 2012;61(6):1165–73.CrossRefPubMed Lukacs B, Loeffler J, Bruyere F, Blanchet P, Gelet A, Coloby P, et al. Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: a multicenter randomized controlled trial. European Urology. 2012;61(6):1165–73.CrossRefPubMed
21.
go back to reference Horasanli K, Silay MS, Altay B, Tanriverdi O, Sarica K, Miroglu C. Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70 mL: a short-term prospective randomized trial. Urology. 2008;71(2):247–51.CrossRefPubMed Horasanli K, Silay MS, Altay B, Tanriverdi O, Sarica K, Miroglu C. Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70 mL: a short-term prospective randomized trial. Urology. 2008;71(2):247–51.CrossRefPubMed
22.
go back to reference Hahn RG. Calculation of irrigant absorption by measurement of breath alcohol level during transurethral resection of the prostate. Br J Urol. 1991;68(4):390–3.CrossRefPubMed Hahn RG. Calculation of irrigant absorption by measurement of breath alcohol level during transurethral resection of the prostate. Br J Urol. 1991;68(4):390–3.CrossRefPubMed
Metadata
Title
Is absorption of irrigation fluid a problem in Thulium laser vaporization of the prostate? A prospective investigation using the expired breath ethanol test
Authors
Livio Mordasini
Dominik Abt
Gautier Müllhaupt
Daniel S Engeler
Andreas Lüthi
Hans-Peter Schmid
Christoph Schwab
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2015
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/s12894-015-0029-2

Other articles of this Issue 1/2015

BMC Urology 1/2015 Go to the issue