THE TRANSURETHRAL RESECTION SYNDROME: AN UNUSUAL COMPLICATION OF POSTERIOR URETHRAL VALVE ABLATION

Abstract

A male prenatally diagnosed with posterior urethral valves and bilateral hydronephrosis was born elsewhere at 38 4⁄7 weeks of gestation. Voiding cystourethrography shortly after birth revealed posterior urethral valves with bilateral grade V reflux but no urinary extravasation. On day 1 of life creatinine was 0.8 mg./dl. (normal 0.6 to 1.1), while on day 2 preoperative serum electrolyte evaluation demonstrated sodium 141 mmol./l. (normal 135 to 145) and chloride 106 mmol./l. (normal 98 to 110). Transurethral valve ablation was performed on day 2 of life using water irrigation and a pediatric resectoscope. Operative time was 1 hour 15 minutes. A seizure occurred within 2 hours of the completion of this apparently uncomplicated procedure. Serum electrolyte evaluation at that time demonstrated sodium 113 mmol./l. and chloride 85 mmol./l. The neonate was treated intravenously with normal saline. During the next 2 days sodium slowly increased to 139 mmol./l. and creatinine to 2.8 mg./dl. Because of worsening renal function the newborn was transferred to our tertiary care facility. At presentation the abdomen was tense and scrotal swelling was evident. Abdom-