The impact of irrigating fluid absorption on blood coagulation in patients undergoing transurethral resection of the prostate A prospective observational study using rotational thromboelastometry

초록

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-alpha-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.

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