Transurethral resection syndrome from extravascular absorption of irrigating fluid

An analysis was made of the clinical course of 20 transurethral resections of the prostate performed under epidural analgesia in which between 676 and 3,600 ml of irrigating fluid containing glycine had been absorbed by the extravascular route. Symptoms consisted in arterial hypotension (n = 14), postoperative oliguria (n = 11), nausea (n = 10), bradycardia (n = 7), abdominal discomfort (n = 5) and visual disturbances (n = 2). There was a significant correlation between hypotension and postoperative oliguria. The hyponatraemia at the end of the operation was only one third of the values obtained if the same amount of irrigating fluid had been absorbed by the intravascular route. Suprapubic drainage of the absorbed fluid (n = 8) did not reduce the hyponatraemia and prolonged the postoperative stay in hospital. Diuretics is an alternative to surgical drainage in all but the most severe cases of extravasation, but should be postponed until normovolaemia is restored and the circulation is stable.