Smoking increases the risk of large scale fluid absorption during transurethral prostatic resection

We studied the association between smoking habits and absorption during transurethral prostatic resection in healthy patients, and in those with medical disease and prostate cancer.

Smoking habits and the presence of medical disease and prostate cancer in 1,034 patients who underwent transurethral prostatic resection were compared with fluid absorption levels. These levels were measured by the ethanol method and surgical blood loss, as determined by a photometer.

The incidence of fluid absorption greater than 1,000 ml. was 15.7% in the present smokers, 15.5% in the past and present smokers, and 8.8% in those who had never smoked. Compared to nonsmokers, the relative risk of 1,000 to 2,000 ml. fluid absorbed in past and present smokers was 1.8 (95% confidence interval 1.1 to 2.9). The corresponding relative risk of absorption greater than 2,000 ml. was 2.1 (95% confidence interval 1.1 to 4.3), with the greatest excess risk in present smokers, which was 2.8 (1.3 to 5.9). These differences between smokers and nonsmokers were even greater in the healthiest patients, while being relatively smaller in those with medical disease or prostate cancer. Fluid absorption correlated with the amount of blood lost but the demonstrated association between smoking and fluid absorption (p <0.024) could not be explained by an effect on blood loss.

Past and present smoking increases the risk of large scale fluid absorption during transurethral prostatic resection. A possible reason is that smoking alters vascular growth in the gland.