Hypo-osmolar intravascular volume overload during anaesthesia for transurethral prostatectomy. A report of 2 cases

Two cases are reported in which absorption of surgical irrigant into the vascular system during transurethral resection of the prostate gland (TUR) resulted in life-threatening complications due to hypo-osmolar volume overload (also known as water intoxication or the TUR syndrome). Manifestations common to both cases were haemolysis of red cells, cardiac arrhythmias, a drop in the serum sodium level, and an elevated central venous pressure. In addition, one patient developed acute pulmonary oedema and the other hypokalaemia, confusion and visual disturbances due to cerebral oedema. Water as an irrigant for TUR should be superseded by glycine 1,5%, which is safer.