Hemolysis in transurethral resection of the prostate using distilled water as the irrigant

To investigate the incidence and time course of hemolysis and its clinical effects following transurethral resection of the prostate (TURP) using distilled water as the irrigant.

Between March 1996 and April 1997, 39 patients who underwent TURP due to benign prostatic hyperplasia (BPH) were randomly included in this study. The levels of plasma hemoglobin, haptoglobin and serum lactic dehydrogenase (LDH) were checked in all patients before, immediately after, and 24 hours after the operation. Serum creatinine and sodium were also checked in 24 patients starting August 1996. Significant hemolysis was identified as simultaneous elevation of plasma hemoglobin (> 10 g/dL), serum LDH and reduction of plasma haptoglobin after TURP.

Among the 39 subjects, hemolysis occurred in 17 (43.6%), whose plasma hemoglobin and serum LDH increased while plasma haptoglobin decreased immediately after operation (p < 0.05), but no significant differences between the data before and 24 hours after the operation were noticed. In the hemolysis group, serum creatinine increased while serum sodium decreased immediately after operation (p < 0.05), but the data before and 24 hours after the operation had no significant differences. There were no changes in serum creatinine and sodium levels after TURP in patients without hemolysis. The weight of the resected prostate was 42.5 +/- 15.5 g in the hemolysis group and 23.3 +/- 8.3 g in the nonhemolysis group, while duration of TURP was 68.9 +/- 19.6 minutes in the hemolysis group and 34.2 +/- 8.4 minutes in the nonhemolysis group. Patients with hemolysis had higher resection weight and longer resection time than those without hemolysis (p < 0.001).

Using distilled water as an irrigant for TURP might cause hemolysis, especially in patients with larger prostates and longer resection times. It is necessary to carry out every effort to shorten resection time and avoid extravasation during surgery.