Irrigation fluid temperature modulates coagulation and endothelial biomarkers in patients undergoing TURP

TL;DR

Using cold irrigation fluid during prostate surgery impairs blood clotting and platelet function, while preheating the fluid helps maintain normal coagulation.

Contribution

This study reveals how irrigation fluid temperature affects coagulation and endothelial markers during TURP surgery.

Findings

Hypothermic irrigation prolonged APTT and reduced platelet count and aggregation.

Preheated irrigation preserved coagulation stability and reduced adverse events.

ET-1 levels decreased most in the preheating group, indicating better endothelial preservation.

Abstract

The temperature of irrigation fluid is a crucial yet frequently neglected factor affecting perioperative hemostasis during transurethral resection of the prostate (TURP). Although the clinical implications of hypothermia are well-documented, its biochemical effects on coagulation processes and endothelial markers are not fully elucidated.

Ninety patients with benign prostatic hyperplasia undergoing TURP were randomized into three groups based on irrigation fluid temperature: hypothermia (24-26 °C), mild hypothermia (28-35 °C), and preheating (36-37 °C). Peripheral blood was collected preoperatively and 6 h postoperatively to evaluate coagulation and endothelial indices, including prothrombin time (PT), activated partial thromboplastin time (APTT), platelet count (PLT), platelet aggregation rate (Pagt), and endothelin-1 (ET-1).

Hypothermia significantly prolonged APTT and reduced PLT and Pagt compared with preheating (P < 0.05), indicating impaired intrinsic pathway activity and platelet dysfunction. PT remained unchanged across groups. ET-1 levels decreased in both hypothermia and preheating groups, with the greatest reduction in preheating, suggesting differential endothelial responses. Patients in the preheating group exhibited preserved coagulation stability and fewer adverse events (6.7%) compared with hypothermia (33.3%) and mild hypothermia (23.3%) groups (P = 0.038).

Hypothermic irrigation significantly prolonged APTT, reduced platelet count, and impaired aggregation capacity, while preheating maintained hemostatic homeostasis.