The endoscopic surgical monitoring system-guided impact factors exploring of blood loss and fluid absorption during plasmakinetic TURP: a prospective study in high-risk BPH patients.

OBJECTIVE

To determine impact factors affecting intraoperative blood loss and fluid absorption by utilizing a novel endoscopic surgical monitoring system (ESMS) for objective quantification in high-risk benign prostatic hyperplasia (BPH) patients undergoing transurethral plasmakinetic resection of the prostate (PK-TURP).

METHODS

This prospective cohort study enrolled 512 high-risk BPH patients undergoing PK-TURP. The ESMS was employed to monitor blood loss and fluid absorption in real-time and non-invasively during the surgery. Univariable and multivariable linear and logistic regression analyses were used to identify factors associated with blood loss (and > 300 ml) and fluid absorption (and > 1000 ml).

RESULTS

Multivariable analyses showed prostate volume, operation time, resected tissue weight, venous sinus opening and present smoking (10-20cigs/d, > 20cigs/d) were independent risk factors of blood loss and fluid absorption (all P < 0.05). Surgical capsule perforation was a significant risk factor for fluid absorption (and > 1000 ml) (B:100.47, P=0.008; OR:2.917, P=0.015). Preoperative finasteride treatment (7days-3months, >3months) and surgeon's experience (50-250 procedures, 250-500 procedures, > 500 procedures) were factors associated with lower odds of blood loss and fluid absorption (all P < 0.05).

CONCLUSION

Prostate volume, operation time, resected tissue weight, venous sinus opening, and present smoking (10-20cigs/d, > 20cigs/d) increase the risk of blood loss and fluid absorption during PK-TURP in high-risk patients. Preoperative finasteride treatment (7days-3months, >3months) and surgeon's experience (50-250 procedures, 250-500 procedures, > 500 procedures) reduce these risks, while surgical capsule perforation significantly increases fluid absorption risk. The ESMS represents an innovative tool for real-time blood loss and fluid absorption monitoring, enabling precision identification of impact factors and enhancing perioperative decision-making.