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

Abstract

Eight patients undergoing transurethral resection of the prostate (TURP) using sterile distilled water as an irrigating fluid were studied. The concentrations of plasma haemoglobin, serum sodium, serum prostatic acid phosphatase protein (PAP) and plasma osmolality were determined as possible indicators of absorption of irrigating fluid. In 3 patients there was a marked increase in plasma haemoglobin immediately postoperatively with a maximum of 3.3 g haemoglobin/l plasma. In the remaining 5 patients the plasma haemoglobin level did not exceed 0.7 g/l immediately postoperatively. In all cases there was a fairly rapid return of the elevated plasma haemoglobin level to preoperative values. There was also a postoperative increase in the serum PAP level which was not correlated with the simultaneous increase in plasma haemoglobin concentration. There was no significant change in the sodium, potassium or albumin concentration in serum nor in plasma osmolality postoperatively. There was some decrease in the postoperative serum creatinine and uric acid levels. The preoperative serum creatinine concentration was within reference limits in 7 patients and borderline high in 1 patient. The haemoglobin binding plasma protein haptoglobin showed a slight non-significant increase immediately postoperatively and a significant decrease in concentration 2 hours postoperatively. The mean plasma haemoglobin concentration immediately postoperatively did not exceed the mean preoperative haemoglobin binding capacity of serum. The mean preoperative haemoglobin binding capacity was 1.2 g/l and the mean plasma haemoglobin level was 1.2 g/l immediately postoperatively. Two hours later the mean plasma haemoglobin level was 0.8 g/l. The mean serum haptoglobin concentration was 2.4 g/l preoperatively, 2.6 g/l immediately postoperatively and 2.0 g/l 2 hours later.(ABSTRACT TRUNCATED AT 250 WORDS)

The Use of Distilled Water as an Irrigating Fluid in Patients Undergoing Transurethral Resection of the Prostate

“…ing kidney damage, excessive bleeding and shock [13]. As we found in the study, there is a direct correlation between A P-Hb which reflects the magnitude of haemo lysis and the inflowing irrigant water (r = 0.69 and between A P-Hb with resecting time and the weight of the resected prostate (r = 0.54 and r = 0.52, respectively).…”

“…The efficacy of intravesical irrigation with distilled water after transurethral bladder tumor removal to reduce the recurrence rate and its possible destruction of free cells in the bladder was shown in our previous studies [11,12], The use of distilled water as an irrigating fluid has several other advantages, such as the absence of electric conductivity and metabolic effects, haemolysis of eryth rocytes in the bladder which gives a clear visual field and a large volume of distribution equal to the total body water [13].…”

The control of haemolysis during transurethral resection of the prostate when water is used for irrigation: monitoring absorption by the ethanol method

“…The magnitude of the decrease is considered to correlate with haemodilution from absorption of the irrigating fluid. When water is used for irrigation, serum Na is a less useful marker of absorption, as the water molecules are rapidly distributed in the total body water, with little tendency to cause dilutional hyponatraemia [8]. In the present study the changes in serum Na were small and insignificant.…”

Does intraprostatic vasopressin prevent the transurethral resection syndrome?

“…Any possible irrigant entry during TURP was assessed in the present study using three independent diagnostic measures; free haemoglobin, serum sodium and breath alcohol. Although irrigant volume changes continue for ≈ 4 h after TURP, changes in haemoglobin are maximal at the end of the procedure [7], and thus a blood sample was taken immediately after TURP; the changes were very small. In the four patients who had some decrease in free haemoglobin, this was a dilutional response to the volume of isotonic saline infused during the procedure.…”

“…This prospective study comprised 36 consecutive men (mean age 68 years, range 54–85) with prostates of ≥ 20 g who underwent TURP using water as the irrigant. Blood samples were taken before and immediately after TURP to measure free haemoglobin and serum sodium concentrations [7,8]. In 20 of the 36 patients the irrigant (cooled, boiled water) contained 1% alcohol and the patients' breath alcohol content was monitored using a breathalyser (Alcolmeter, Lion Laboratories plc, Cardiff, Wales) at 10‐min intervals.…”