Conventional Fluid Management Versus Plethysmography Variability Index-based Goal-directed Fluid Management in Patients Undergoing Transurethral Resection of the Prostate-a Randomized Controlled Trial

Transurethral resection of the prostate (TURP) is a widely performed surgical procedure for the management of benign prostatic hyperplasia, which affects a significant number of elderly men . TURP involves the removal of prostate tissue via the urethra and is associated with potential fluid shifts, blood loss, and hemodynamic instability. Effective fluid management during the procedure is crucial to ensure optimal patient outcomes, minimizing complications such as hypotension, acute kidney injury, and electrolyte imbalances .

Because of the constant and frequently undetectable fluid exchange through the open prostatic venous sinuses, it is difficult to determine the precise amount of irrigating fluid absorbed after TURP surgery. Unpredictable intravascular volume changes may result from this. While over-resuscitation raises the risk of fluid overload, pulmonary edema, and cardiac events, under-resuscitation in older individuals can lead to hypotension and decreased organ perfusion Fluid management in TURP has always depended on traditional techniques that employ clinical evaluations like blood pressure and heart rate monitoring or fixed-volume infusion procedures. Although the goal of these methods is hemodynamic stability, they might not be accurate in dynamically adapting to the specific requirements of each patient, especially when there are large fluid shifts. Furthermore, these approaches frequently overlook the fluctuations in patients' hemodynamic state in real time, which may result in either excessive or insufficient resuscitation By using advanced technologies, goal-directed fluid therapy (GDFT) methods continually monitor and evaluate a patient's physiological status in real time, modifying fluid dosage as necessary. A dynamic method for determining volume status, the plethysmography variability index (PVI) has been studied in numerous clinical settings and has proven reliable in predicting fluid responsiveness and acting as a fluid resuscitation guide .

The PVI has been shown to perform similarly to more invasive and expensive dynamic fluid assessment technologies (such as pulse pressure variation and stroke volume variation) . A small-sized randomized controlled trial (RCT) showed that PVI-directed fluid management reduced the lactate concentrations and improved fluid management in abdominal surgery recipients .

Nevertheless, the clinical outcomes of conventional fluid management with PVI-based GDFT were investigated in previous studies like colorectal surgeries and spine surgeries; we did not find a previous study investigating this strategy in elderly patients undergoing TURP surgery .

This randomized controlled trial (RCT) aims to compare the clinical outcomes of conventional fluid management with PVI-based GDFT in patients undergoing TURP. We hypothesize that PVI-guided fluid management will result in better intraoperative hemodynamic stability, a reduction in postoperative complications, and an overall improvement in patient recovery.