Patients developing overt symptoms due to absorption of irrigating fluid were first described in connection with transurethral resection of the prostate (TURP). This “transurethral resection (TUR) syndrome” soon proved to be due to uptake of more than 3 L of irrigant.
The most commonly used irrigating fluids used today contain glycine, sorbitol or mannitol, to prevent hemolysis in case they are absorbed. These fluids are intended for monopolar electrocautery.
Symptoms of fluid absorption occurs in between 1% and 8% of the TURPs performed. Absorption in excess of 1Lof glycine solution is associated with a statistically increased risk of symptoms. This has been reported in between 5% and 20% of the TURPs performed. Extravasation is the cause in about 20% of these patients.
The TUR syndrome induced by an electrolyte-free irrigating fluid has a complex pathophysiology. Key elements comprise a two-stage cardiovascular disturbance, hyponatremia, and cerebral edema.
Absorption of electrolyte-free irrigating fluid can be estimated by measuring serum sodium at the very end of surgery. Ethanol has been added to the irrigating fluid to a concentration of 1% and the body concentration measured used an index of the fluid absorption. Both experimental and clinicalstudies support the usefulness of treating the TUR syndrome with hypertonic saline. Supporting the hemodynamics with adrenergic drugs is also warranted.
Large-scale fluid absorption with normal saline is a possibility during bipolar resection. Treatment should probably be limited to general supportive measures and diuretics. Hypertonic saline is not indicated.
Cambridge: Cambridge University Press , 2011. 148-156 p.