Prospective evaluation of irrigation fluid absorption during pure transurethral bipolar plasma vaporisation of the prostate using expired‐breath ethanol measurements
Bibliographic record
Abstract
OBJECTIVES: To investigate if absorption of irrigation fluid occurs during bipolar plasma vaporisation (BPV) of the prostate. To examine the clinical predictors of increased risk of fluid absorption and to assess if changes in serum electrolytes, venous pH, haemoglobin or haematocrit are able to detect intra-operative fluid absorption. PATIENTS AND METHODS: Over a 15-month period, 55 consecutive patients undergoing BPV of the prostate were investigated. The volume of intra-operative fluid absorption was measured using expired-breath ethanol measurements. Intra-operative irrigation was performed with isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min during the operation and the volume of irrigation fluid absorption was calculated from these concentrations. Data on clinical (age, prostate volume, smoking status) and surgical variables (operation time, irrigation volume, appearance of capsular perforation) as well as intra-operative changes in serum electrolytes, venous pH, haemoglobin and haematocrit were recorded. RESULTS: The median (range) age of the patients was 67 (48-87) years and the median (range) prostate volume was 41 (17-111) mL. Nine patients (16%) showed a positive ethanol breath test during the procedure. The median (range) calculated fluid absorption in these patients was 346 (138-2166) mL. Three patients had a fluid absorption >500 mL. One patient with absorption of >2 L showed clinical symptoms (dyspnoea and agitation) during the operation under spinal anaesthesia. In the group of patients with fluid absorption, capsular perforation or injury to larger vessels was more often detectable. In the group of patients with fluid absorption, only venous pH showed a significant change during the operation (from median 7.41 to median 7.34, P = 0.02). The pH decrease was significantly greater in the fluid absorption group than in the group of patients without fluid absorption (0.09 vs. 0.02, P = 0.005). CONCLUSION: We have demonstrated that significant intra-operative fluid absorption can occur during BPV of the prostate. Care must be taken if using this procedure in patients with significant cardiovascular comorbidities. Respecting the anatomical borders of the prostate seems to play a relevant role in preventing fluid absorption during the procedure. Venous pH could be used to detect potentially dangerous fluid absorption if intra-operative monitoring with breath ethanol measurements is not available.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".