Clinical profile and safety outcomes of TURP using sterile water as irrigation fluid”: A retrospective observational study.

Abstract

Background: Transurethral resection of Prostate (TURP) is a surgical procedure for managing bladder outlet obstruction secondary to benign prostatic hyperplasia. The procedure requires continuous irrigation to maintain visibility, remove tissue debris, and prevent complications such as clot formation. Despite the entry of LASERs in prostate surgery, TURP is still a gold standard surgery practiced widely in the peripheral centers due to comparable results and affordable/less expensive. Glycine, sterile water, Normal saline, dextrose in water, mannitol, sorbitol are few of the irrigation fluids used during TURP (11,14). During the surgical procedure, exposure of venous sinuses and injury to the prostatic capsule lead to systemic absorption of irrigation fluids, resulting in several complications including fluid overload, pulmonary edema, congestive heart failure, hyponatremia, and hypothermia. Glycine may have toxic effects on the heart and the kidneys as the absorbed glycine is metabolized to ammonia in the liver leading to hyperammonemia which may cause neurologic complications such as tremors and seizures. Massive absorption of sorbitol can also cause hyperglycemia and lactic acidosis and coagulopathy. Concerns and limitations including cost factors are associated with irrigation fluids.(13) Emerging interest in sterile water as a potentially safer alternative is increasing due to similar safety profile and outcomes in the form reduced risk of TURP syndrome and systemic absorption issues and cost factors (3,4,6,8,12). The present study was conducted to evaluate the clinical profile and safety outcomes of using sterile water as an irrigation fluid in TURP procedures and to compare these outcomes with available literature which used other irrigation fluids.
Materials and Methods: This is a retrospective cohort study. 150 patients were included in the study. We have included the patients undergoing TURP procedures using sterile water as irrigation fluids. Information retrieved from Medical records department includes patient's socio-demographic data, investigation profile (Hb%, serum electrolytes, prostate size) intra-operative findings, the volume of irrigation fluid used, cost factor of irrigation fluid, post-operative complications including length of the hospital stay.
Results: Prostate volume ranges from 30 to 162 ml with a mean of 91 ml while resected prostate volume ranges from 6cc to 128 ml with a mean of 67 ml. Volume of the sterile water used as irrigation fluid ranged from 5.0 L to 90 .0 L with a mean of 47.5 L. Duration of resection ranged from 15 min to 80 min with mean of 47.5 min. Mean reduction in International Prostate Symptoms Score, improvement in Q-max and reduction in post-void residual urine were 20, 10.5 and 105 ml, respectively. Transfusion rate was 1.3 % while the duration of admission ranges from 2 to 6 days, with a mean of 2.5 days. The overall early complication rate was 6.6%. No statistically significant changes were reported in the serum sodium, blood urea nitrogen, creatinine, and hematocrit.
Conclusion: Sterile water as a irrigation fluid is safe and is and comparable to other expensive irrigation fluids like glycine in terms of safety profile, clinical outcome and render the treatment affordable. Future research, including randomized controlled trials to validate these findings are required.