Mannitol Concentrations in Blood Plasma in Connection with Transurethral Resection of the Prostate Using Mannitol Solution as An Irrigating Fluid

Abstract

Thirteen patients undergoing transurethral resections of the prostate (TURP) using iso-osmolar 5% mannitol as an irrigating fluid were studied. Mannitol was determined in serum (plasma), as were sodium, prostatic acid phosphatase protein (PAP) and osmolality as probable indicators of absorption of irrigating fluid. The plasma level of mannitol (mean 2.7 g/l = 15 mmol/l) immediately postoperatively, the increase in serum PAP (mean 93 micrograms/l) and the decrease in serum sodium (mean 8.7 mmol/l) all reflect the amount of irrigating fluid absorbed during TURP. The three variables are intercorrelated. The plasma osmolality was unchanged (mean -1 mosmol/kg). A small but constant fraction of mannitol was found in the erythrocytes 2 hours after the operation, amounting to about 3% of the simultaneous plasma concentration. The mean plasma half-life of mannitol was 127 min in the absence of uraemia. In two cases showing a slight increase in serum creatinine the half-lives were prolonged. An estimate of the volume of fluid absorbed was made from the observed plasma mannitol levels. A fluid absorption of up to 3 litres (mean 1.1 l) was found. A strong diuretic effect was observed in some cases when irrigation with mannitol was combined with i.v. furosemide. We conclude that the i.v. diuretic should be withheld until the extent of fluid absorption has been estimated. If the sodium concentration in the serum is largely unchanged immediately postoperatively, diuresis can be induced by an intravenous diuretic.

Sorbitol-Mannitol Solution for Urological Electrosurgical Resection – A Safer Fluid than Glycine 1.5%

“…There were no major adverse events encountered and no patient developed the TUR syndrome. In all respects, other than choice of irrigant fluid, these patients were similar to previously reported series [2][3][4][5][6][7].…”

Plasma Haemoglobin Concentrations and Other Influx Variables in Blood in Connection with Transurethral Resection of the Prostate Using Distilled Water as an Irrigating Fluid

“…The treatment and surgical technique have been described previously (21,22). It should be pointed out, however, that the operations were carried out with intermittent bladder irrigation using sterile distilled water (Travenol Laboratories, Deerfield, Ill., USA) as an irrigating fluid.…”

“…Thus no signs of haemodilution were seen, whereas haemodilution effects are obtained when iso-tonic solutions are used as irrigating fluids (22,23,24).…”

“…Subsequently, various undesirable effects were encountered with such solutions: plasma and extracellular fluid volume expansion (8) with a temporary decrease in, for instance, the sodium concentration in serum. When mannitol is used as an irrigating fluid solute a marked prolongation of the half-life in plasma is obtained when kidney function is even slightly impaired (22,28). Sorbitol is also influenced by kidney function but more so by liver H .…”

A Comparison Between two Hypotonic Irrigating Solutions used in Transurethral Resections of the Prostate: Sorbitol (2%)-Mannitol (1%) and 1.5% Glycine Solutions

“…In healthy individuals its half-life in plasma is of the order of 150 min. Mannitol clearance is of the order of the glomerular filtration rate (1, 9).…”