Validation of the ethanol breath test and on-table weighing to measure irrigating fluid absorption during transurethral prostatectomy

Objective To determine the agreement between on-table weighing and the ethanol breath test in measuring the fluid absorption of patients during transurethral prostatectomy (TURP), and to assess the practicality of on-table weighing in the clinical setting. Patients and methods The absorption of irrigating fluid by the patient during TURP can lead to adverse sequelae, including cardiac stress. Despite modern techniques irrigant may still be absorbed and therefore methods to detect absorption are important. Most methods are impractical or inaccurate, but the expired ethanol technique and continuous on-table weighing are more promising. TURP was undertaken in 44 men (mean age 71 years) using continuous flow 1.5% glycine/1% ethanol as the irrigating solution. Intraoperative irrigant absorption was calculated by the ethanol breath test, using published formulae. Absorption measured by the weighing machine was calculated as (weight gain+blood loss-fluid given), and blood loss by the Hemocue method. Results The mean (SD) resected weight was 23 (14) g at a mean resection rate of 0.74 g/min. The mean (range) absorption using the balance was 456 (-343 to 2486) mL, and using the ethanol breath test was 435 (44-2750) mL, with the mean of the differences being -17 mL, with a 95% confidence interval (CI) of -81 to -40, the 95% limits of agreement being - 389 to 356 mL, (95% CI -458 to -337 and 297 to 418 mL). Conclusions Both methods are comparable and measure irrigating fluid absorption to levels of accuracy that are useful clinically. Either method could (and should) be used in routine practice.