Rapid communication: bipolar PlasmaKinetic transurethral resection of the prostate: reliable training vehicle for today's urology residents.
OBJECTIVE
With the improvement of medical therapy and minimally invasive surgical treatments for benign prostatic hyperplasia, the number of transurethral resections of the prostate (TURPs) done in training is decreasing. With fewer TURPs being performed, proficiency in this basic urologic technique has decreased, causing longer resection times. This often leads to a higher risk of fluid absorption, water toxicity, and hyponatremia (TUR syndrome). We examined the safety of bipolar electrocautery TURP (saline TURP) with the Gyrus PlasmaKinetic system using normal saline as irrigant.


METHODS
Twenty-one men aged 54 to 85 years (median 70.0 years) underwent saline Plasma- Kinetic TURP from June 2002 to August 2003. Serum sodium, chloride, hemoglobin, and hematocrit were measured 1 hour prior to and 1 hour after TURP. Resection time, tissue weights, hospital stay, and catheter time were recorded and analyzed.


RESULTS
The median preresection and postresection sodium concentrations were 139.0 mEq/mL and 140.0 mEq/L, respectively (ranges 130-142 mEq/L and 134-143 mEq/L). The corresponding chloride values were 106.5 mEq/L and 109.0 mEq/L (ranges 102-114 mEq/L and 106-116 mEq/L), and the hemoglobin and hematocrit values were 13.4 g/dL and 40.1 g/dL (8.7-15.2 g/dL and 33.7-46.7 g/dL) and 12.0 g/dL and 36.6 g/dL (8.2-14.4 g/dL and 27.5-43.7 g/dL), respectively. The median resection time was 65 minutes (range 45-140 minutes), and the median resected tissue weight was 20 g (range 5-61 g). There was no statistically significant difference between the preresection and postresection sodium concentrations, and no patient exhibited any clinical sign of TUR syndrome.


CONCLUSIONS
Gyrus PlasmaKinetic TURP using normal saline as the irrigant is a safe alternative to and is technically no different from traditional monopolar TURP. The system also provides the longer time needed to train urology residents without compromising patient safety.
Gilleran
Jason P
JP
Department of Urology, University of Illinois, Chicago, Illinois 60612, USA.
Thaly
Rahul K
RK
Chernoff
Allen M
AM
D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000295:instrumentation; D002712:Chlorides / Q000097:blood; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000601:surgery*; D012965:Sodium Chloride; D007507:Therapeutic Irrigation; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*; D014835:Volatilization; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000517:prevention & control*
D002712:Chlorides; D006454:Hemoglobins; D007552:Isotonic Solutions; D012965:Sodium Chloride