PII: S0002-9378(96)70415-5

Abstract

The transurethral resection syndrome is defined as confusion, hypotension, bradycardia, malaise, and collapse during transurethral resection of the prostate. It was initially described by Creevy et al.1Creevy CD. The importance of hemolysis during the transurethral prostatic resection: a clinical investigation.J Urol. 1948; 59: 1217-1232PubMed Google Scholar This symptom complex is an infrequent finding after transcervical resection and was not found in our study. However, the primary symptoms in our patients were nausea, vomiting, and headache. Demonstrable changes in the cardiovascular system did not occur. Fluid overload was defined as absorption of >2000 ml of uterine irrigant.2Baumann R Magos AL Kay JD Turnbull AC. Absorption of glycine irrigating solution during transcervical resection of endometrium.BMJ. 1990; 300: 304-305Crossref PubMed Scopus (71) Google Scholar In our series of 101 patients 4.5% absorbed >2000 ml of glycine (Table I) and these patients had nausea, vomiting, and headache. The symptoms, with respect to absorption of fluid in women undergoing transcervical resection, seems to be different compared with the findings in men undergoing resection of the prostate. Table IDeficit of glycine solution in 101 patients0-500 ml500-1000 ml1000-1500 ml1500-2000 ml>2000 ml46.8%28.9%7.2%12.6%4.5% Open table in a new tab In 1994 our group initiated a study on cerebral edema and nausea after transcervical resection. Patients with a glycine deficit of ≥1000 ml or lowering of sodium concentrations of 10 mmol/L or more all had nausea and a diagnosis of cerebral edema on computed tomographic scan. The results suggest that discrete cerebral edema may contribute to the development of postoperative nausea in patients undergoing transcervical surgery with significant absorption of the glycine irrigating solution.3Istre O Bjoennes J Naess R Hornbaek K Forman A Postoperative cerebral oedema after transcervical endometrial resection and uterine irrigation with 1.5% glycine.Lancet. 1994; 344: 1187-1189Abstract PubMed Scopus (116) Google Scholar The current evidence suggests that previous limits of the amount of fluid absorption allowed before interruption of transcervical surgery of 1500 to 2000 ml may be too high. It should not exceed 1000 ml until the consequences of minor cerebral edema after transcervical resection is known. Major absorption of irrigation solution takes place through damaged vessels in the myometrium. Vasopressin causes vasoconstriction, and theoretically that could reduce the amount of irrigation solution being brought into the circulation; however, in Europe this drug has been connected to complications during surgery.4Bryssine B Raudrant D Champion F Bouletreau P. Lysine-vasopressin in gynecologic surgery by the vaginal route: hemodynamic study.Presse Med. 1995; 24: 26-28PubMed Google Scholar As a consequence, ornipressin was prohibited in France in 1990. It is possible that the use of the rollerball technique would reduce the incidence of fluid absorption and subsequently the incidence of nausea. However, the fact that 35% of our patients had intracavitary fibroids implies that resectoscopic techniques are preferable and monitoring of the deficit volume directly during operative hysteroscopy is required. 6/8/70055