Effect of warm bladder irrigation fluid for benign prostatic hyperplasia patients on perioperative hypothermia, blood loss and shiver: A meta-analysis

doi:10.1016/j.ajur.2018.07.001

Asian Journal of Urology, 2019, 6 (2): 183-191 doi: 10.1016/j.ajur.2018.07.001

Review

Effect of warm bladder irrigation fluid for benign prostatic hyperplasia patients on perioperative hypothermia, blood loss and shiver: A meta-analysis

Jie Cao^a,Xia Sheng^b,1,Yan Ding^a,Lingjuan Zhang^c,*(

),Xiaoying Lu^c,*(

)

a.Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China;
b.Department of Robotic Urology Operating Theatre, Changhai Hospital, Second Military Medical University, Shanghai, China;
c.Nursing Department, Changhai Hospital, Second Military Medical University, Shanghai, China

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Abstract

Objective To find out whether warm bladder irrigation fluid can decrease the occurrence of perioperative hypothermia, blood loss and shiver in patients treated with benign prostatic hyperplasia (BPH).Method A comprehensive literature review and meta-analysis that included randomized controlled trials (RCTs) related to temperature of irrigation fluid in the perioperative treatment for BPH was taken by researchers. The relevant literature were searched in Chinese database, such as Retrieval Chinese Journal Full-text Database, VIP Journal Database, Wanfang database, as well as in English search engine and database, including Embase, Cochrane and Medline till January 2018. The study quality was assessed by recommended standards from Cochrane Handbook (version 5.1.0).Results A total of 28 RCTs and 3858 patients were included. The results showed that the incidences of shiver (risk ratio [RR] = 0.32, 95% confidence interval [CI]: 0.28-0.36, p < 0.001, I ² = 0%) and hypothermia (RR = 0.36, 95% CI: 0.21-0.59, p < 0.001, I ² = 67%) in the group of warm irrigation fluid were lower than the group having room-temperature fluid. Room-temperature irrigation fluid group caused a greater drop in body temperature compared to warm irrigation fluid group (p < 0.001, I ² = 96%). We performed a narrative descriptive statistics only because of substantial heterogeneity.Conclusions Warm bladder irrigation fluid can decrease the drop of body temperature and the incidence of hypothermia and shiver during and after the operation for BPH. Warm irrigation fluid should be considered as a standard practice in BPH surgeries.

Key words： Irrigation fluid Temperature Bladder fluid Benign prostatic hyperplasia Hypothermia Blood loss Shiver

Received: 09 June 2017 Available online: 18 July 2018

Corresponding Authors: Xia Sheng,Lingjuan Zhang,Xiaoying Lu E-mail: lindazhang_cn@hotmail.com;luxiaoyingjoy@163.com

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Cite this article:

Jie Cao,Xia Sheng,Yan Ding, et al. Effect of warm bladder irrigation fluid for benign prostatic hyperplasia patients on perioperative hypothermia, blood loss and shiver: A meta-analysis[J]. Asian Journal of Urology, 2019, 6(2): 183-191.

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http://www.ajurology.com/EN/10.1016/j.ajur.2018.07.001 OR http://www.ajurology.com/EN/Y2019/V6/I2/183

Flow chart of data selection and extraction. RCTs, randomized controlled trials; BPH, benign prostatic hyperplasia.

Study: author, year, country	Type of surgery	Warmed group (n)	RT group (n)	Temperature of Irrigation in warmed group (°C)	Temperature of Irrigationin RT group (°C)	Monitoring method	Sequence generation	Allocation concealment	Baseline comparability	Loss of follow-up	Blinding	Selective outcome reporting
Xu et al. (2008), China [3]	TURP	30	30	36-38	RT	Lower esophageal temperature	Un	Un	Good	No	Un	Un
Zheng et al. (2012), China [6]	TUVP	29	28	30-35	RT	Anal-temperature	Random numbers table	Un	Good	No	Un	Un
Ren and Wang (2007), China [7]	TURP	45	45	37-38	RT	Anal-temperature	Un	Un	Good	No	Un	Un
Fu et al.(2004), China [9]	TURP	31	31	37-38	RT	Anal-temperature	Un	Un	Good	No	Un	Un
Guo et al. (2009), China [10]	TURPK	30	30	36-37	RT	Anal-temperature	Un	Un	Good	No	Un	Un
Yang et al. (2015), China [11]	TUVP	38	38	36	RT	Anal-temperature	Un	Un	Good	No	Un	Un
Chen and Ma (2016), China [12]	HoLEP	54	52	35-37	RT	Un	Random numbers table	Un	Un	No	Un	Un
Yang and Tan (2015), China [13]	TURP	43	43	37	RT	Axillary-temperature	Un	Un	Good	No	Un	Un
Zhang (2006), China [14]	TURPK	47	49	36-37	RT	Anal-temperature	Un	Un	Good	No	Un	Un
Zuo (2007), China [15]	TURP	50	30	37-38	RT	Anal-temperature	Un	Un	Good	No	Un	Un
Li (2010), China [16]	TURP	150	150	Axillary-temperature	RT	Un	Un	Un	Good	No	Un	Un
Zheng (2012), China [17]	TURP	150	150	Axillary-temperature +0.5	RT	Un	Un	Un	Good	No	Un	Un
Wang et al. (2012), China [18]	TURP	62	57	33-38	RT	Un	Un	Un	Good	No	Un	Un
Wang and Nin (2007), China [19]	TURP	78	78	Anal-temperature	RT	Anal-temperature	Un	Un	Good	No	Un	Un
Xie et al.(2009), China [20]	TURP	28	28	36-38	RT	Anal-temperature	Random numbers sequence	Un	Good	No	Un	Un
Okeke (2007), Nigeria [21]	TURP	40	40	38	RT	Un	Draw lots	Un	Good	No	Un	Un
Pit et al.(1996), the Netherlands [22]	TURP	28	31	Anal-temperature	RT	Un	Un	Un	Good	No	Single blind	Un
Chen (2015), China [23]	TURPK	50	50	37	RT	Un	Random numbers table	Un	Good	No	Un	Un
Hu et al. (2013), China [24]	TURP	35	32	32-35	RT	Axillary-temperature	Un	Un	Good	No	Un	Un
Li (2008), China [25]	TURP	33	33	37-38	RT	Anal-temperature	Un	Un	Un	No	Un	Un
Rajeev et al. (2014), India [26]	TURP	20	20	37	RT	Un	Un	Un	Good	No	Un	Un
Wang 2007), China [27]	TURP	50	50	36-38	RT	Anal-temperature and axillary-temperature	Un	Un	Good	No	Un	Un
Yang (2013), China [28]	TURP	200	200	Axillary-temperature	RT	Un	Un	Un	Good	No	Un	Un
Zhang (2016), China [29]	TURP	600	500	35-37	RT	Un	Un	Un	Good	No	Un	Un
Zhu et al. (2012), China [30]	TUPKVP	25	25	37	RT	Anal-temperature	Un	Un	Good	No	Un	Un
Lu et al. (2012), China [31]	TURP	45	45	36.5-37.5	RT	Anal-temperature	Unknown	Unknown	Good	No	Un	Un
Zhong (2015), China [32]	TURP	30	30	37	RT	Un	Un	Un	Good	No	Un	Un
Li (2014), China [33]	TURP	21	21	34-37	RT	Un	Visiting sequence	Un	Good	No	Un	Un

General information and quality assessment of included literature.

The value of perioperative body temperature drop for warmed group and room-temperature group. Std, standard; SD, standard difference; CI, confidence interval. CI, confidence interval.

The incidence of perioperative shiver for warmed group and room-temperature group. CI, confidence interval.

The incidence of perioperative hypothermia for warmed group and room-temperature. CI, confidence interval.

Sensitivity analysis of the incidence of perioperative hypothermia for warmed group and room-temperature. CI, confidence interval.

The value of perioperative blood loss for warmed group and room-temperature group. CI, confidence interval.

Inverted funnel plot of perioperative temperature drop. SMD, standardised mean difference; SE, standard error.

Inverted funnel plot of perioperative shiver. SE, standard error; RR, risk ratio.

Inverted funnel plot of perioperative hypothermia. SE, standard error; RR, risk ratio.

Inverted funnel plot of perioperative blood loss. SE, standard error; MD, mean difference.

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