2099 DOES MONOPOLAR TRANSURETHRAL PROSTATECTOMY USING WATER IRRIGATION RESULT IN CLINICALLY SIGNIFICANT HYPONATREMIA?

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology1 Apr 20112099 DOES MONOPOLAR TRANSURETHRAL PROSTATECTOMY USING WATER IRRIGATION RESULT IN CLINICALLY SIGNIFICANT HYPONATREMIA? Ernesto III Arada and Allen Porin Ernesto III AradaErnesto III Arada Quezon City, Philippines More articles by this author and Allen PorinAllen Porin Quezon City, Philippines More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2295AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this era of bipolar transurethral prostatectomy in saline (TURIS), monopolar transurethral prostatectomy (TURP) with non-electrolytes still has a place. During monopolar TURP, irrigating fluids like glycine and water are invariably absorbed and may cause hyponatremia. In developing countries, water irrigation is still widely used in monopolar TURP because it is more economical than glycine. Our aim is to determine if water irrigation during monopolar TURP results in clinically significant hyponatremia, TUR syndrome and other complications. METHODS Data from 70 male patients was analyzed prospectively. All patients underwent monopolar TURP using water irrigation for obstructing enlarged prostates under spinal anesthesia. Serum sodium was taken immediately after TURP and compared with preoperative levels. Hyponatremia was defined as decrease in serum sodium of 5 nmol/l or more in comparison to preoperative values. Signs and symptoms of hyponatremia were recorded after TURP. Hyponatremia was also correlated with resection time, specimen weight and blood loss. RESULTS Mean age of patients was 68.54 years (range: 50–85). All 70 patients had mean resection time of 57.55 minutes (Range: 15–130); mean specimen weight of 49.73 grams (Range: 15–149); and mean blood loss of 262.78 ml (Range: 50–1000). Only 24 patients (34%) went over one hour of TURP. Preoperatively, all patients had normal CBC, serum creatinine and serum sodium levels. Pre-TURP mean serum sodium was 140.64 nmol/l (Range: 135–148). Post-TURP mean serum sodium was 138.35 nmol/l (Range: 127–147). Hyponatremia after TURP developed in 14 patients (20%). The 14 post-TURP hyponatremic patients had mean resection time of 63.69 minutes, mean specimen weight of 50.33 grams and mean blood loss of 209.09 ml. These hyponatremic patients were also noted to have longer resection times, similar specimen weights and lower blood loss compared to the 56 post-TURP normonatremic patients undergoing monopolar TURP. Only one hyponatremic patient (7%) showed signs of TUR syndrome without further consequence. The other 13 hyponatremic patients (93%) did not show any clinical signs or symptoms of hyponatremia like vomiting, seizures or changes in sensorium. No postoperative fever or signs of urinary infection were also observed. CONCLUSIONS Our study showed that one-fifth of patients developed hyponatremia after monopolar transurethral prostatectomy using water irrigation. However, majority of these hyponatremic patients did not develop clinically significant signs and symptoms of hyponatremia. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e838-e839 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ernesto III Arada Quezon City, Philippines More articles by this author Allen Porin Quezon City, Philippines More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...