Original Article

Sterile Water as an Irrigating Fluid for Transurethral Resection of the Prostate: Anesthetical View of the Records of 1600 Cases

Authors: Reza Shariat Moharari, MD, Mohammad Reza Khajavi, MD, Peyman Khademhosseini, MD, Seyed Reza Hosseini, MD, Atabak Najafi, MD

Abstract

Objectives: Absorption of the fluid used for bladder irrigation during transurethral resection of prostate (TURP) may disturb the circulatory system and lead to clinical symptoms known as the transurethral resection syndrome. The purpose of this study was to evaluate the changes in electrolytes in patients who had undergone TURP.


Methods: For all the cases with benign prostatic hypertrophy enrolled in the present study, TURP was performed as recommended in Miller's Anesthesia, the sixth edition. Sterile water was used as an irrigating fluid for bladder washing. Laboratory tests were performed before and immediately after the surgery.


Results: No statistically significant changes were reported in the serum sodium, blood urea nitrogen, creatinine, and hematocrit. The most common complications were hypotension (8.3%), hypertension (7.8%), nausea (6.4%), and vomiting (2.8%). Hyponatremia, decreased hematocrit, and increased blood urea nitrogen/creatinine were rarely reported (2.5, 1.0, and 0.9%, respectively).


Conclusion: Sterile water has been shown to be a safe irrigating fluid for TURP.


Key Points


* Absorption of the fluid used during TURP may disturb the circulatory system and lead to transurethral resection syndrome.


* Using sterile water as irrigating fluid, there were no statistically significant changes in serum sodium, blood urea nitrogen, creatinine, and hematocrit before and after the operation.


* Hypotension, hypertension, nausea, and vomiting were the most common complications; hyponatremia, decreased hematocrit, and increased blood urea nitrogen/creatinine were rarely reported.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Olsson J, Nilsson A, Hahn RG. Symptoms of the transurethral resection syndrome using glycine as the irrigant. J Urol 1995;154:123–128.
 
2. Hahn RG, Sanfeldt L, Nyman CR. Double blind randomized study of symptoms associated with absorption of glycine 1.5% or monitol 3% during transurethral resection of the prostate. J Urol 1998;160:397–401.
 
3. Hagstrom RS. Studies on fluid absorption during transurethral prostatic resection. J Urol 1955;73:852–859.
 
4. Wein AJ, Kavoussi LR, Novick AC, et al. Campbell Walsh Urology. Philadelphia, Saunders Elsevier, 2007, ed 9.
 
5. Malhotra V, Sudheendra V, Diwan S. Anesthesia and the renal and genitourinary system, in Miller RD (ed): Miller's Anesthesia. Philadelphia, Elsevier Churchill Livingstone, 2005, ed 6, pp 2189–2194.
 
6. Harrison RH, Boren JH, Robinson JR. Dilutional hyponatremic shock: another concept of the transurethral prostatic resection. J Urol 1956;75:95–110.
 
7. Shih HC, Kang HM, Yang CR, et al. Safety of distilled water as an irrigating fluid for transurethral resection of the prostate. Zhonghua Yi Xue Za Zhi 1999;62:503–508.
8. Hahn RG. Early detection of the transurethral resection syndrome by marking the irrigating fluid with 1% ethanol. Acta Anaesthesiol Scand 1989;33:146–151.
 
9. Verrili RA, Uhlman RC, Viek NF, et al. The hypotensive effect of prostatic extract. J Urol 1962;87:184–186.
 
10. Hahn R, Stalberg H, Carlstrom K, et al. Plasma atrial natriuretic peptide concentration and rennin activity during overhydration with 1.5% glycine solution in conscious sheep. Prostate 1994;24:55–61.