title: The impact of irrigating fluid absorption on blood coagulation in patients undergoing transurethral resection of the prostate: A prospective observational study using rotational thromboelastometry.
abstract: Although endoscopic transurethral resection of the prostate (TURP) is a well-established procedure as a treatment for benign prostatic hyperplasia, its complications remain a concern. Among these, coagulopathy may be caused by the absorption of irrigating fluid. This study aimed to evaluate such phenomenon using a rotational thromboelastometry (ROTEM).A total of 20 patients undergoing TURP participated in this study. A mixture of 2.7% sorbitol-0.54% mannitol solution and 1% ethanol was used as an irrigating fluid, and fluid absorption was measured via the ethanol concentration in expired breath. The effects on coagulation were assessed by pre- and postoperative laboratory blood tests, including hemoglobin, hematocrit, platelet count, international normalized ratio of prothrombin time (PT-INR), activated partial thromboplastin time, electrolyte, and ROTEM.INTEM-clotting time (INTEM-CT) was significantly lengthened by 14% (P = 0.001). INTEM-α-angle was significantly decreased by 3% (P = 0.011). EXTEM-clot formation time was significantly prolonged by 18% (P = 0.008), and EXTEM-maximum clot firmness (EXTEM-MCF) was significantly decreased by 4% (P = 0.010). FIBTEM-MCF was also significantly decreased by 13% (P = 0.015). Moreover, hemoglobin (P < 0.001), hematocrit (P < 0.001), platelet counts (P < 0.001), potassium (P = 0.024), and ionized calcium (P = 0.004) were significantly decreased, while PT-INR (P = 0.001) was significantly increased after surgery. The amount of irrigating fluid absorbed was significantly associated with the weight of resected prostatic tissue (P = 0.001) and change of INTEM-CT (P < 0.001).As shown by the ROTEM analysis, the irrigating fluid absorbed during TURP impaired the blood coagulation cascade by creating a disruption in the coagulation factor activity or by lowering the coagulation factor concentration via dilution.
authors.affiliation: aDepartment of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si bDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Hyun-Jung
authors.initials: HJ
authors.lastname: Shin
authors.forename: Hyo-Seok
authors.initials: HS
authors.lastname: Na
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Jeon
authors.forename: Hee-Pyoung
authors.initials: HP
authors.lastname: Park
authors.forename: Sun-Woo
authors.initials: SW
authors.lastname: Nam
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Hwang
mesh_terms: D000368:Aged; D001777:Blood Coagulation; D006801:Humans; D008297:Male; D011446:Prospective Studies; D007507:Therapeutic Irrigation; D013916:Thrombelastography; D020728:Transurethral Resection of Prostate