Absorption of irrigating fluid during percutaneous transrenal lithotripsy.

Twenty-eight patients who underwent percutaneous lithotripsy with isotonic mannitol solution as the irrigating fluid were studied. Intraoperative intravenous and total absorption of irrigating fluid was estimated from postoperative analyses of plasma and urinary concentrations of mannitol. Most operating times were short and only minor fluid absorption was recorded. In six cases, however, the fluid absorption exceeded 100 ml and two of these had a maximal calculated absorption of more than 1000 ml (1220 and 1860 ml, respectively). Intraoperative bleeding was a warning sign of absorption of irrigating fluid.

A comparison between two hypotonic irrigating solutions used in transurethral resections of the prostate: sorbitol (2%)-mannitol (1%) and 1.5% glycine solutions.

Two hypotonic but non-haemolysing irrigating solutions, sorbitol-mannitol (2% + 1%) and glycine (1.5%), were compared in 40 TURP cases using a continuous resection technique. Ethanol (1%) was added to the irrigating fluid as a marker to make possible early detection of fluid absorption by breath analysis. Mannitol and sorbitol were determined in plasma and urine; glycine and ethanol were determined in plasma. Apparent absorbed fluid volumes were calculated from the immediate postoperative plasma concentrations of ethanol, mannitol, sorbitol and glycine and from the elimination of mannitol in urine during 24 hours following the operation. The use of a continuous operating technique with a suprapubic trocar resulted in very small absorptions (less than 1 l) in this series. The concentrations of the two solutes in the sorbitol-mannitol irrigating fluid were balanced so that the plasma concentrations immediately postoperatively were of the same order when absorption occurred. The sorbitol concentration declined more rapidly than the mannitol concentration in conformity with previous findings. In most cases the peak plasma level was observed immediately postoperatively but in some cases at a later time (during the interval 0-2 hours), indicating absorption from a depot of fluid accumulated extravesically in addition to direct intravenous absorption. The best estimate of fluid absorption seems to be obtained from the urinary elimination of mannitol, followed by estimates based on the plasma mannitol concentration immediately postoperatively. The plasma ethanol level determined at the same time gave an estimate of the same order, whereas plasma sorbitol and glycine levels gave lower estimates (owing to rapid redistribution and metabolism).(ABSTRACT TRUNCATED AT 250 WORDS)

Water and electrolytes in muscle tissue and free amino acids in muscle and plasma in connection with transurethral resection of the prostate. II. Isotonic 2.2% glycine solution as an irrigating fluid.

Seventeen patients undergoing transurethral resection of the prostate using isotonic 2.2% glycine solution as an irrigating fluid were studied. The extra- and intracellular distribution of water, the total content of water, and the concentrations of electrolytes and free amino acids in muscle tissue were determined together with the concentrations of free amino acids in plasma preoperatively, immediately postoperatively and 2, 6, 24 and 48 hours postoperatively in two groups with separate sampling periods. There were no significant changes in water content and sodium or chloride concentrations in muscle tissue postoperatively. Potassium and magnesium concentrations decreased late in the postoperative phase. In plasma there was a fifty-fold increase immediately postoperatively in the glycine concentration (mean fluid absorption 0.71) followed by a six-fold increase in muscle tissue 6 hours postoperatively. The glycine metabolite serine also increased in plasma and muscle. Other muscle amino acid concentrations decreased immediately postoperatively probably due to the massive glycine entrance into the cells. Later postoperative changes in some muscle amino acids (glutamine, glutamate, alanine, tyrosine and arginine) may be explained more by the operative trauma than by the influence of glycine. Two different types of metabolic effects are seen in this material. The first is that of the glycine infusion and the metabolic effects of glycine. The second is the catabolic influence of the surgical trauma. Accumulation of glycine in tissues in some patients with the possible production of ammonia and the effects of glycine as an inhibitory neurotransmitter must be considered as risk factors when choosing glycine as an irrigating fluid.

Water and electrolytes in muscle tissue and free amino acids in muscle and plasma in connection with transurethral resection of the prostate. I. Distilled water as an irrigating fluid.

10 patients undergoing transurethral resection of the prostate using sterile distilled water as an irrigating fluid were studied. The extra- and intracellular distribution of water, the total content of water and electrolytes and the free amino acid concentrations in muscle tissue were determined together with the concentrations of free amino acids in plasma preoperatively, immediately postoperatively and 2 hours postoperatively. The content of water and concentrations of electrolytes in skeletal muscle did not change significantly from the preoperative to the postoperative period with the exception of the potassium concentration, which decreased 2 hours postoperatively. The following free amino acid concentrations in muscle tissue showed significantly decreased values 2 hours postoperatively compared with the preoperative values: taurine, serine, glutamate, proline and leucine. The concentrations of non-essential amino acids in muscle decreased significantly 2 hours postoperatively. This may be interpreted as a dilution effect. An increased concentration of some amino acids in plasma postoperatively may be explained as a haemoconcentration effect due to the use of a postoperative diuretic.

Testicular hydrocele treated by bismuth phosphate injection.

Thirty-eight testicular hydroceles were treated by injection with 0.2-0.4 g of bismuth phosphate. The follow-up was completed in 32 cases, 17 (53%) of which showed complete regression although one patient had to wait 24 months for full regression. Eight patients (25%) showed clinical improvement and one patient (3%) had residual scrotal tenderness after otherwise successful treatment. Six patients (19%) did not improve and were treated surgically. The method may present an alternative to surgery in elderly patients with testicular hydrocele.

Absence of lactate accumulation on transurethral resection of the prostate using 2.5% sorbitol solution as an irrigating fluid.

19 patients with benign hyperplasia of the prostate were studied. During transurethral resection of the prostate, 2.5% sorbitol solution was used as an irrigating fluid. Blood samples were taken preoperatively, immediately postoperatively, and 60 and 120 min postoperatively. Samples were analysed for sorbitol metabolites (fructose, glucose, lactate and pyruvate) and inorganic phosphate. The series was divided into two groups, one with low absorption and one with high absorption of irrigating fluid. The limit for the plasma sorbitol concentration immediately postoperatively, dividing the groups, was 1.0 mmol/l, corresponding to an absorbed fluid volume of about 0.1 l. There was a slight increase in lactate and a significant decrease in pyruvate in the blood in both groups postoperatively. Blood fructose was zero in the group with low absorption of irrigating fluid whereas there was a slight increase in the group with high absorption, with a maximum of 0.53 mmol fructose/l. Blood glucose did not show any significant changes postoperatively. Inorganic phosphate in serum showed a significant decrease postoperatively in both groups. There were no significant differences between the groups at the various postoperative sampling times with regard to lactate, pyruvate, glucose or inorganic phosphate in the blood. Thus, we did not observe any accumulation of lactate in the blood when using 2.5% sorbitol solution as an irrigating fluid with absorbed fluid volumes up to 1 litre (corresponding to 25 g sorbitol).

Experience with hypotonic 2.5% sorbitol solution as an irrigating fluid in transurethral resection of the prostate.

19 patients were studied in connection with transurethral resection of the prostate using the intermittent technique and hypotonic 2.5% sorbitol solution as an irrigating fluid. No diuretics were given postoperatively. In 2 patients there was a slight elevation of the serum creatinine level preoperatively but in 17 patients serum creatinine was within the reference limits. The plasma sorbitol concentration was determined at 20-min intervals for two hours. The mean plasma concentration of sorbitol immediately postoperatively was 379 mg/l (2.1 mmol/l) and the highest level observed was 1,900 mg/l (10.6 mmol/l). The half-life for sorbitol in plasma was 21 min (mean calculated in 11 cases). The range was 11-33 min. With increasing immediate postoperative plasma sorbitol levels there was also an increase in the half-life, corresponding to saturation of the sorbitol metabolizing enzyme system. The absorbed fluid volumes were calculated from the immediate postoperative plasma concentration of sorbitol, which gave a mean of 0.23 1 and a maximum of 1.01. Haemodilution effects with decrease in the serum sodium and serum albumin concentrations were noted, but they were much less marked than when 5% sorbitol solution was used as an irrigating fluid. There were only insignificant increases in the plasma haemoglobin concentrations postoperatively, which were probably due to heat decomposition of red blood cells in the bladder during the operation. About 7% of the absorbed amount of sorbitol was eliminated in the urine (mean). The highest value observed was 18% in the case showing the highest plasma sorbitol concentration immediately postoperatively (1,900 mg/l). Sorbitol was eliminated in the urine over a period of 6 hours postoperatively.