symptoms, known as the transurethral resection syndrome. Few cases of fever or hypothermia were reported in our
The prevalence of the syndrome varies in different studies, study. According to Hahn et al,2 postoperative fever was
which might be related to factors including the type of chem- common in those who absorbed irrigating fluid (21%) com-
ical fluid used for irrigation (eg, sterile water, mannitol, gly- pared with only 3% of the nonabsorbing patients. They sug-
cine, etc), the osmotic characteristic of the irrigating fluid gested that fluid absorption promotes bacteremia after TURP.
(hypo-, normo-, or hyperosmolar fluids), the patient’s condi- The nature of the prostatic hypertrophy, elective surgery, and
tion, and the amount of fluid absorbed.2,3,7,8 According to hygienic methods of surgery may reduce the abovementioned
Hagstrom3, the susceptibility of patients to develop these events.
symptoms varies according to their age and physical condi-
Some investigators have shown that the fluid’s temper- Conclusion
ature interacts with the complications.1 The fluid bags with TURP with sterile water is safe and inexpensive. Signif-
the room temperature of 37°C, which were traditionally used icant hyponatremia and fluid absorption did not occur, and
in our center, prevent some cardiovascular changes and hypo- there was no mortality.
Some authors suggested that hypertension is caused by Acknowledgments
the fluid overload in the clinical syndrome during and after We thank all patients who let us use their information.
TURP, though it maybe followed by dilutional hyponatremic Also, we thank all urologists, anesthesiologists, and their res-
shock.1 The results of Hahn et al’s2 research showed that idents for helping us. We gratefully acknowledge Dr. Patricia
hypertension occurred in approximately 20% of the patients Khashayar for reviewing this manuscript and providing help-
who underwent TURP regardless of the amount of the ab- ful comments.
sorbed fluid. On the contrary, hypotension was strongly as-
sociated with the increase of absorption during and after the
procedure. The cause of hypotension is not as clear as the
1. Olsson J, Nilsson A, Hahn RG. Symptoms of the transurethral resection
cause of hypertension, but it maybe the result of acute hypo- syndrome using glycine as the irrigant. J Urol 1995;154:123–128.
natremia,6 dissemination of vasoactive substances from the
2. Hahn RG, Sanfeldt L, Nyman CR. Double blind randomized study of
operating field,9 and the circulation itself.10 Significant hem- symptoms associated with absorption of glycine 1.5% or monitol 3%
orrhage also increases the risk of intraoperative decreases in during transurethral resection of the prostate. J Urol 1998;160:397– 401.
the arterial pressure. In our study, hypertension was reported 3. Hagstrom RS. Studies on fluid absorption during transurethral prostatic
in 7.8% of the cases, which maybe related to other situations resection. J Urol 1955;73:852– 859.
such as the prevalence of hypertension in the elderly in Iran. 4. Wein AJ, Kavoussi LR, Novick AC, et al. Campbell Walsh Urology.
Hypotension was somewhat more frequent, but it may not be Philadelphia, Saunders Elsevier, 2007, ed 9.
a serious problem, as many cases only had the transient form, 5. Malhotra V, Sudheendra V, Diwan S. Anesthesia and the renal and
genitourinary system, in Miller RD (ed): Miller’s Anesthesia. Philadel-
probably due to some amounts of bleeding. This condition
phia, Elsevier Churchill Livingstone, 2005, ed 6, pp 2189 –2194.
could be easily managed by serum therapy and the re-balanc-
6. Harrison RH, Boren JH, Robinson JR. Dilutional hyponatremic shock:
ing of the body fluids. Also, the frequency of cardiac arrhyth- another concept of the transurethral prostatic resection. J Urol 1956;75:
mias maybe related to the patients’ age; the most frequent 95–110.
forms were premature atrial contraction and premature ven- 7. Shih HC, Kang HM, Yang CR, et al. Safety of distilled water as an
tricular contraction, which are more common in the elderly irrigating fluid for transurethral resection of the prostate. Zhonghua Yi
individuals. As mentioned above, body temperature was con- Xue Za Zhi 1999;62:503–508.
trolled during the operation and the fluid of the normal body 8. Hahn RG. Early detection of the transurethral resection syndrome by
marking the irrigating fluid with 1% ethanol. Acta Anaesthesiol Scand
temperature was used. This might lead to a significant reduc-
tion in the occurrence of cardiac arrhythmias. Olsson et al1
9. Verrili RA, Uhlman RC, Viek NF, et al. The hypotensive effect of
showed the symptoms of bradycardia, hypotension, and im- prostatic extract. J Urol 1962;87:184 –186.
paired diuresis after transurethral resection of the prostate
10. Hahn R, Stalberg H, Carlstrom K, et al. Plasma atrial natriuretic peptide
were associated with each other. In our study, oliguria was concentration and rennin activity during overhydration with 1.5% gly-
seen in only one patient. cine solution in conscious sheep. Prostate 1994;24:55– 61.
Southern Medical Journal • Volume 101, Number 4, April 2008 3