title: Is absorption of irrigation fluid a problem in Thulium laser vaporization of the prostate? A prospective investigation using the expired breath ethanol test.
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
  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.
  
  
  CONCLUSIONS
  The aim of this study is to assess the safety of Thulium Laser TUV-P in regard to absorption of irrigation fluid.
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. livio.mordasini@icloud.com.
authors.forename: Livio
authors.initials: L
authors.lastname: Mordasini
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. dominik.abt@kssg.ch.
authors.forename: Dominik
authors.initials: D
authors.lastname: Abt
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. gautier.muellhaupt@kssg.ch.
authors.forename: Gautier
authors.initials: G
authors.lastname: Müllhaupt
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. daniel.engeler@kssg.ch.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Engeler
authors.affiliation: Department of Anaesthesiology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. andreas.luethi@kssg.ch.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lüthi
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. hans-peter.schmid@kssg.ch.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Schmid
authors.affiliation: Department of Urology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. christoph.schwab@kssg.ch.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwab
mesh_terms: D065567:Absorption, Physiological; D000328:Adult; D001944:Breath Tests / Q000379:methods; D000431:Ethanol / Q000493:pharmacokinetics; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007432:Intraoperative Period; D007552:Isotonic Solutions; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000378:metabolism; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012965:Sodium Chloride / Q000493:pharmacokinetics; D013932:Thulium; D020728:Transurethral Resection of Prostate / Q000379:methods
chemical_list: D007552:Isotonic Solutions; D000431:Ethanol; D012965:Sodium Chloride; D013932:Thulium