Prevention of irrigating fluid absorption during transurethral resection of the prostate. 1984

J Hultén

This thesis contains studies on the prerequisites for fluid absorption during transurethral resection of the prostate (TURP) and suggestions on its prevention. The pressure gradient bladder-prostatic fossa to pelvic veins and its relation to fluid absorption were studied in patients using a sensitive detection technique with a radionuclide. It is concluded that to prevent fluid entering the vascular system, the bladder pressure should be kept below the pressure in the pelvic veins. The physical properties of the irrigating jet of resectoscopes were investigated in model experiments including an artificial, "bleeding" prostatic fossa. The dynamic pressure of the jet amounts to only 1-3% of the driving head and thus is of marginal importance in fluid absorption. The effect of various flow rates on the optical field was also demonstrated. In patients with prostatism epidural and spinal analgesia increased the bladder capacity but always with a corresponding increase in bladder pressure. In a preliminary study a correlation was found between the minimum urethral resistance and the compliance of the detrusor during epidural analgesia. This may suggest a relation between prostatic obstruction and changes of the viscoelastic properties of the bladder wall. The effects of various irrigating flow rates on the pressure-volume response of the bladder and its relation to the pressure in the pelvic veins was also investigated. From this study it was concluded that the detrusor response was unaffected by flow rates used during TURP. The critical bladder pressure above which fluid is absorbed changed with the position of the patient. In the Trendelenburg (20 degrees) position it was 0.25 kPa (approximately equal to 2.5 cmH2O), increasing to 1.25 kPa in the horizontal and 1.75 kPa in the half-sitting (20 degrees) position. To prevent absorption bladder pressure must be monitored. A simple pressure warning device with an adjustable warning level and which can be combined with any irrigating technique is presented. Irrigation with a large driving head may thus be combined with a low pressure resection.

UI MeSH Term Description Entries
D007507 Therapeutic Irrigation The washing of a body cavity or surface by flowing water or solution for therapy or diagnosis. Douching,Lavage,Douchings,Irrigation, Therapeutic,Irrigations, Therapeutic,Lavages,Therapeutic Irrigations
D008297 Male Males
D010388 Pelvis The space or compartment surrounded by the pelvic girdle (bony pelvis). It is subdivided into the greater pelvis and LESSER PELVIS. The pelvic girdle is formed by the PELVIC BONES and SACRUM. Pelvic Region,Region, Pelvic
D011467 Prostate A gland in males that surrounds the neck of the URINARY BLADDER and the URETHRA. It secretes a substance that liquefies coagulated semen. It is situated in the pelvic cavity behind the lower part of the PUBIC SYMPHYSIS, above the deep layer of the triangular ligament, and rests upon the RECTUM. Prostates
D011470 Prostatic Hyperplasia Increase in constituent cells in the PROSTATE, leading to enlargement of the organ (hypertrophy) and adverse impact on the lower urinary tract function. This can be caused by increased rate of cell proliferation, reduced rate of cell death, or both. Adenoma, Prostatic,Benign Prostatic Hyperplasia,Prostatic Adenoma,Prostatic Hyperplasia, Benign,Prostatic Hypertrophy,Prostatic Hypertrophy, Benign,Adenomas, Prostatic,Benign Prostatic Hyperplasias,Benign Prostatic Hypertrophy,Hyperplasia, Benign Prostatic,Hyperplasia, Prostatic,Hyperplasias, Benign Prostatic,Hypertrophies, Prostatic,Hypertrophy, Benign Prostatic,Hypertrophy, Prostatic,Prostatic Adenomas,Prostatic Hyperplasias, Benign,Prostatic Hypertrophies
D001794 Blood Pressure PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS. Systolic Pressure,Diastolic Pressure,Pulse Pressure,Pressure, Blood,Pressure, Diastolic,Pressure, Pulse,Pressure, Systolic,Pressures, Systolic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000042 Absorption The physical or physiological processes by which substances, tissue, cells, etc. take up or take in other substances or energy.
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D013523 Surgical Equipment Nonexpendable apparatus used during surgical procedures. They are differentiated from SURGICAL INSTRUMENTS, usually hand-held and used in the immediate operative field. Equipment, Surgical,Equipments, Surgical,Surgical Equipments

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