Feasibility of serial perioperative lung ultrasound to monitor fluid shifts during thulium laser prostate enucleation

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• Picked for Physiology (medical) (paper of the day, 10 August 2026).

Abstract

PURPOSE: Irrigation fluid absorption (IFA) during transurethral surgery of the prostate continues to pose a risk for fluid overload and electrolyte imbalance, yet reliable methods for quantifying absorption remain limited. Lung ultrasound (LU), increasingly used to detect pulmonary pathology, provides a noninvasive approach to assess fluid accumulation. METHODS: In this prospective single-center observational study, 36 patients aged ≥ 60 years undergoing elective urethral-sparing Thulium: YAG anatomical endoscopic enucleation of the prostate (AEEP; ThuLEP) were examined. LU was performed preoperatively and postoperatively by trained investigators, and a modified Lung Ultrasound Score (mLUS) was calculated. Perioperative data included body weight, fluid balance, biochemical parameters, and hemodynamic variables. Associations between mLUS and perioperative parameters were evaluated using Spearman correlation and linear regression analyses. RESULTS: Median postoperative mLUS values increased significantly from baseline (0 (IQR 0-1) vs. 7.5 (IQR 4.5-10.5), p < 0.0001). Overall fluid balance correlated with both postoperative mLUS (ρ = 0.51, p = 0.003) and change in mLUS (ρ = 0.40, p = 0.023). The change in body weight correlated with intraoperative fluid balance (ρ = 0.66, p < 0.001), overall fluid balance (ρ = 0.58, p < 0.001), and serum chloride increase (ρ = 0.53, p = 0.007). In a simple linear regression model, overall fluid balance was associated with the change in mLUS (β = 0.00073, 95% CI 0.00015-0.00131, p = 0.015). In a multivariable linear regression model, greater overall fluid balance (p = 0.015) and chloride increase (p = 0.001) were associated with larger increases in body weight. The median weight of removed prostate tissue was 61.5 g (IQR 42-88.5), with 0.92 g per minute. CONCLUSION: LU detected postoperative pulmonary fluid accumulation and correlated with perioperative fluid balance in elderly patients undergoing AEEP. Changes in serum chloride concentration and body weight were associated with systemic fluid uptake.

Abstract as published, via PubMed.