{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:13:23Z","timestamp":1755216803370,"version":"3.43.0"},"reference-count":20,"publisher":"Walter de Gruyter GmbH","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Holmium Laser Enucleation of the Prostate (HoLEP) is a widely used minimally invasive surgical technique for benign prostatic hyperplasia (BPH), offering advantages such as reduced bleeding, shorter hospitalization, and elimination of TURP syndrome. However, complications related to fluid absorption and capsular perforation can still occur. We report a rare case of severe refractory metabolic acidosis and acute abdominal compartment syndrome (ACS) following HoLEP.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case Presentation<\/jats:title>\n                  <jats:p>A 74-year-old male with diabetes and hypertension underwent HoLEP for a 180-ml prostate, during which 106 liters of normal saline irrigation were used over three hours. Intraoperatively, the patient developed sudden respiratory distress and hypotension, with arterial blood gas analysis revealing severe metabolic acidosis (pH 7.141, HCO<jats:sub>3<\/jats:sub> 11 mEq\/L, Cl 115 mEq\/L), primarily due to excessive saline absorption and hyperchloremia. The patient required intubation, vasopressor support, and emergency dialysis due to worsening hemodynamic instability. Postoperative imaging revealed intra-abdominal fluid collection, which was drained percutaneously. After two days of intensive ICU management, the acidosis resolved, and the patient was successfully extubated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This is the first case highlighting the potential risks of normal saline absorption and the effect of capsular perforation, which caused ACS and refractory acidosis, and required CRRT due to the prolonged duration of HoLEP.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2478\/jccm-2025-0027","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T19:57:30Z","timestamp":1754337450000},"page":"301-306","source":"Crossref","is-referenced-by-count":0,"title":["Refractory metabolic acidosis and acute abdominal compartment syndrome following Holmium Laser Enucleation of Prostate (HoLEP)"],"prefix":"10.2478","volume":"11","author":[{"given":"Murugananth","family":"Nithiyananthan","sequence":"first","affiliation":[{"name":"Singapore General Hospital, Singapore , Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shitalkumar Sharad","family":"Shah","sequence":"additional","affiliation":[{"name":"Singapore General Hospital, Singapore , Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aarthi","family":"Suhitharan","sequence":"additional","affiliation":[{"name":"National Junior College, Singapore , Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suhitharan","family":"Thangavelautham","sequence":"additional","affiliation":[{"name":"Singapore General Hospital, Singapore , Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"2025080421042721537_j_jccm-2025-0027_ref_001","unstructured":"Das AK, Teplitsky S, Humphreys MR. Holmium laser enucleation of the prostate (HoLEP): a review and update. Can J Urol. 2019 Aug;26(4 Suppl 1):13\u201319."},{"key":"2025080421042721537_j_jccm-2025-0027_ref_002","doi-asserted-by":"crossref","unstructured":"Chung DE, Te AE. New techniques for laser prostatectomy: an update. Ther Adv Urol. 2009;1(2):85\u201397.","DOI":"10.1177\/1756287209105436"},{"key":"2025080421042721537_j_jccm-2025-0027_ref_003","unstructured":"Michalak J, Tzou D, Funk J. HoLEP: the gold standard for the surgical management of BPH in the 21st century. Am J Clin Exp Urol. 2015 Apr 25;3(1):36\u201342."},{"key":"2025080421042721537_j_jccm-2025-0027_ref_004","unstructured":"Pang KH, Ortner G, Yuan Y, Biyani CS, Tokas T. Complications and functional outcomes of endoscopic enucleation of the prostate: a systematic review and meta-analysis of randomised-controlled studies. 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