銩雷射攝護腺剜除手術中絞碎腺瘤時的灌洗溶液是否會對視野有所影響:

一項前瞻性研究

陳鵬¹、黃奕燊^1,2、鍾孝仁^1,2、黃逸修^1,2、林子平^1,2、范玉華^1,2、黃志賢^1,2

¹臺北榮民總醫院 泌尿部；

²國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心

Does Irrigation Solution affect Visual Field Clarity during Adenoma Morcellation in Thulium Laser Enucleation of the Prostate: A Prospective Randomized Pilot Study

Peng Chen¹, I-shen Huang^1,2, Hsiao-Jen Chung^1,2, Eric Yi-Hsiu Huang^1,2, Tzu-Ping Lin^1,2, Yu-Hua Fan^1,2, William J. Huang^1,2

¹ Department of Urology, Taipei Veterans General Hospital;

² Department of Urology, School of Medicine, College of Medicine, Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose

Thulium laser enucleation of the prostate (ThuLEP) has been shown to be safe and highly effective in the management of benign prostate enlargement and bladder outlet obstruction. Although ThuLEP can achieve better hemostasis as compared to conventional transurethral resection of the prostate, bladder mucosa injury is possible during morcellation of the prostate adenoma due to such maneuver performed under poor vision secondary to bleeding. Using distilled water as an irrigation solution can improve visual field clarity during adenoma morcellation by lysing red blood cells therefore in this pilot study, we sought to compare the visual field clarity, morcellation efficiency and safety of using distilled water or normal saline as irrigation solution during adenoma morcellation.

Materials and Methods

A prospective randomized study was performed on 30 consecutive patients with benign prostate enlargement who underwent ThuLEP by a single surgeon randomized using either distilled water (n=14) or normal saline (n=16) during adenoma morcellation. The primary outcome was subjective visual clarity score graded as 1 (barely visible), 2 (moderately visible), or 3 (fully visible) of the morcellation video clips given by two independent reviewers. Secondary outcomes were comparison of intra and perioperative parameters (operative time, blood loss, enucleated tissue weight, serum sodium level change, catherization time, length of stay, and intraoperative complications) between the two groups.

Results

The mean prostate size and the resected gland weight were 94.2 mL and 49.3 gm. The distilled water group had a statistically significant higher visual clarity score (2.1 vs. 1.2, p=0.001) compared to normal saline group rated by reviewers. There was no significant difference found between the groups in intra and perioperative parameters: post-operative hemoglobin decrease was comparable (mean: 1.1 vs. 1.2 d/dl, p =0.400) and post-operative changes in serum sodium concentration was similar (mean: 0.4 vs. 0.6 mmol/l, p =0.637) in the two groups. No patient developed hyponatremia or experienced bladder mucosa injury during or after the operation.

Conclusions

After anatomical enucleation of the prostate with Thulium laser, using distilled water as morcellation solution significantly improves visual field clarity and was not associated with an increased risk of hyponatremia as compared to normal saline.