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 Huang1,2, Hsiao-Jen Chung1,2, Eric Yi-Hsiu Huang1,2, Tzu-Ping Lin1,2, Yu-Hua Fan1,2, William J. Huang1,2
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
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.
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.
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.