OBJECTIVE: To examine changes in the pathophysiology of the transurethral resection (TUR) syndrome with various irrigation fluids. PATIENTS AND METHODS: Three different irrigation fluids (5% mannitol in 21 patients, group A; 1.5% glycine in 18 patients, group B; and a fluid containing 2.7% sorbitol and 0.54% mannitol in 20 patients, group C) were compared during transurethral prostatectomy (TURP) by assessing plasma volume expansion, calculated using the haematocrit dilution method, and several biochemical variables. RESULTS: None of the patients experienced TUR syndrome and none showed a change in plasma osmolality (P > 0.05). However, serum sodium, haemoglobin, haematocrit, total protein and albumin levels declined (P < 0.01). The decrease in total protein and albumin level was greater in group A than in groups B and C (P < 0.01 for both). Although the amount of fluid absorbed was the same in all of the groups (P > 0.05), plasma volume expansion was greater in group A than in B or C (P < 0.05 for both). Hyperammonaemia, encountered in group B, was more evident with increasing weight of the resected tissue. However, this increase was insufficient to cause encephalopathy. CONCLUSION: Although it was not important clinically, mannitol solution could cause more evident hypervolaemia than glycine and sorbitol solutions; glycine solution could cause hyperammonemia, but the solution containing mainly sorbitol had no such adverse effects.
RCT Entities:
OBJECTIVE: To examine changes in the pathophysiology of the transurethral resection (TUR) syndrome with various irrigation fluids. PATIENTS AND METHODS: Three different irrigation fluids (5% mannitol in 21 patients, group A; 1.5% glycine in 18 patients, group B; and a fluid containing 2.7% sorbitol and 0.54% mannitol in 20 patients, group C) were compared during transurethral prostatectomy (TURP) by assessing plasma volume expansion, calculated using the haematocrit dilution method, and several biochemical variables. RESULTS: None of the patients experienced TUR syndrome and none showed a change in plasma osmolality (P > 0.05). However, serum sodium, haemoglobin, haematocrit, total protein and albumin levels declined (P < 0.01). The decrease in total protein and albumin level was greater in group A than in groups B and C (P < 0.01 for both). Although the amount of fluid absorbed was the same in all of the groups (P > 0.05), plasma volume expansion was greater in group A than in B or C (P < 0.05 for both). Hyperammonaemia, encountered in group B, was more evident with increasing weight of the resected tissue. However, this increase was insufficient to cause encephalopathy. CONCLUSION: Although it was not important clinically, mannitol solution could cause more evident hypervolaemia than glycine and sorbitol solutions; glycine solution could cause hyperammonemia, but the solution containing mainly sorbitol had no such adverse effects.