Fluid absorption during transurethral prostatectomy.

Area of Science:

• Urology
• Nephrology
• Cardiology

Background:

• Benign prostatic hyperplasia (BPH) is a common condition in aging men.
• Transurethral resection (TUR) of the prostate is a standard surgical treatment for BPH.
• Mannitol is frequently used as an irrigating fluid during TUR procedures.

Purpose of the Study:

• To investigate the absorption of mannitol during transurethral resection of the prostate.
• To assess the effects of absorbed mannitol on serum sodium levels and hemodynamic parameters.
• To identify potential risks associated with high levels of intravascular mannitol.

Main Methods:

• A study involving 39 patients undergoing transurethral resection of the prostate for BPH.
• Measurement of serum mannitol levels during and after the procedure.
• Monitoring of serum sodium levels, blood pressure, and heart rate.
• Assessment of patient hydration status (hypovolemia).

Main Results:

• Significant absorption of mannitol into the circulation was observed in patients.
• A notable decrease in serum sodium levels correlated with mannitol absorption.
• Patients with serum mannitol levels exceeding 4000 mg/l exhibited hypotension and bradycardia.
• Hypovolemia was a common finding in patients with adverse hemodynamic changes.

Conclusions:

• Intravascular mannitol absorption can lead to dilutional hyponatremia and hemodynamic instability during TURP.
• Hypotension and bradycardia in this context may be multifactorial, with intravascular mannitol playing a significant role.
• Close monitoring of serum mannitol levels and hemodynamic status is essential in patients undergoing TURP with mannitol irrigation.