Benign Prostatic Hyperplasia (BPH) is one of the most prevalent causes of LUTS in men, with a prevalence of roughly 40% in men in their fifties and this gradually increases with age. (1) TURP is still the surgical treatment option for BPH. With the advancement of technology, the treatment has undergone numerous changes, resulting in a reduction in perioperative problems. Blood loss is one of the most prevalent post-operative problems that plagues the surgery and adds significantly to peri-operative morbidity. Continuous bladder irrigation is required during TURP, and the most often utilised irrigation fluid is at room temperature, which can lower the core and peripheral body temperatures. Several studies have found that irrigation fluid at room temperature might produce a reduction in body temperature, potentially leading to perioperative hypothermia. Hypothermia during surgery has several drawbacks, including coagulopathy, delayed awakening from anaesthesia, impact on cardiovascular function, lower blood pressure, higher risk of surgical site infection, and shivering. Shivering can make patients feel more uncomfortable, anxious, and need more oxygen. It also puts more strain on the heart, perhaps leading to cardiovascular disease. Renal blood flow and glomerular filtration rate can be dramatically reduced when the sympathetic nerve is stimulated, resulting in renal insufficiency. Body-temperature irrigation fluid will limit the occurrence of perioperative hypothermia and hence avoid the aforesaid adverse effects, particularly coagulopathy, which will reduce intraoperative blood loss and make surgery safer. This study aims to determine the efficacy of warm irrigation solution(37°C) in improving intraoperative bleeding and perioperative outcomes of TURP surgery.

This is a Single-blinded, parallel-arm, Instititional Ethical Comittee approved and Cetral Trial Registry India Regisered (CTRI/2022/09/045235) randomized controlled trial done from August 2022 to February 2024.This analysis included 75% of sample size (n=40). All patients undergoing TURP were included. Patients with uncontrolled hypertension, cardiac disease, and on anticoagulants were excluded. The study group received warm irrigation solution (37°C), whereas the control group received  irrigation solution at OT temperature (22-24°C)  throughout the procedure. Primary outcome was intraoperative blood loss. The secondary outcomes were mean postoperative pain score (at 1 h, 6h, 24h) (Universal pain assessment score), analgesic requirement, and post-op UTI. Incidence of hypothermia, requirement of blood transfusion, ease of surgery, post-op IPSS score at Post Operative Day 10 and length of hospitalization (LOH) were also measured.

This Randomized Controlled Trail included 20 patients in each group. Demographic and clinical profiles were comparable in both groups. The mean blood loss in the study group was significantly lower than the control group [63 (57-72) ml vs 84 (78-110) ml; p<0.001 ]. Incidence of hypothermia was significantly lower in the study group (6.2% vs 76.3%; p<0.001).The  ease of surgery was better with warm saline thus significantly decreasing the resection time (54.32±10.30 minutes vs 95.21±22.56; p=0.021). Rest of the secondary outcomes like mean indwelling catheter time (p=0.84), postoperative complications (p=0.90), and LOH (p=0.68) were comparable in both groups

This is an Randomized Controlled Trail comparing warm irrigation solution vs irrigation with solution at OT temperature  during Transurethral prostate resection. Results showed that the mean blood loss in the study group was significantly lower than in the control group, indicating that using warm irrigation solution reduced intraoperative bleeding. Additionally, the incidence of hypothermia was significantly lower in the study group, suggesting that warm irrigation solution helped maintain body temperature during the surgery.
The study also found that the ease of surgery was better in the warm irrigation group, as indicated by a significantly shorter resection time. However, other secondary outcomes such as mean indwelling catheter time, postoperative complications, and length of hospitalization were comparable between the two groups

In this study warm irrigation solution(37°C) significantly reduced intraoperative blood loss and hypothermia. It aslo  improved vision (as there were less frost and so lesser need to clear the eyepiece repeatedly during resection) and thereby significantly decreasing the time of resection.

Lim KB. Epidemiology of clinical benign prostatic hyperplasia. Asian J Urol. 2017 Jul;4(3):148–51.
Fagerström T, Nyman CR, Hahn RG. Bipolar transurethral resection of the prostate causes less bleeding than the monopolar technique: a single-centre randomized trial of 202 patients. BJU Int. 2010 Jun;105(11):1560-4. doi: 10.1111/j.1464- 410X.2009.09052.x. Epub 2009 Nov 13. PMID: 19912211.
3.	Heathcote PS, Dyer PM. The effect of warm irrigation on blood loss during transurethral prostatectomy under spinal anaesthesia. Br J Urol. 1986 Dec;58(6):669-71. doi: 10.1111/j.1464-410x.1986.tb05909.x. PMID: 3801826.

Continence 12S (2024) 101605
DOI: 10.1016/j.cont.2024.101605