Plasma Haemoglobin Concentrations and Other Influx Variables in Blood in Connection with Transurethral Resection of the Prostate Using Distilled Water as an Irrigating Fluid

Abstract

Eight patients undergoing transurethral resection of the prostate (TURP) using sterile distilled water as an irrigating fluid were studied. The concentrations of plasma haemoglobin, serum sodium, serum prostatic acid phosphatase protein (PAP) and plasma osmolality were determined as possible indicators of absorption of irrigating fluid. In 3 patients there was a marked increase in plasma haemoglobin immediately postoperatively with a maximum of 3.3 g haemoglobin/l plasma. In the remaining 5 patients the plasma haemoglobin level did not exceed 0.7 g/l immediately postoperatively. In all cases there was a fairly rapid return of the elevated plasma haemoglobin level to preoperative values. There was also a postoperative increase in the serum PAP level which was not correlated with the simultaneous increase in plasma haemoglobin concentration. There was no significant change in the sodium, potassium or albumin concentration in serum nor in plasma osmolality postoperatively. There was some decrease in the postoperative serum creatinine and uric acid levels. The preoperative serum creatinine concentration was within reference limits in 7 patients and borderline high in 1 patient. The haemoglobin binding plasma protein haptoglobin showed a slight non-significant increase immediately postoperatively and a significant decrease in concentration 2 hours postoperatively. The mean plasma haemoglobin concentration immediately postoperatively did not exceed the mean preoperative haemoglobin binding capacity of serum. The mean preoperative haemoglobin binding capacity was 1.2 g/l and the mean plasma haemoglobin level was 1.2 g/l immediately postoperatively. Two hours later the mean plasma haemoglobin level was 0.8 g/l. The mean serum haptoglobin concentration was 2.4 g/l preoperatively, 2.6 g/l immediately postoperatively and 2.0 g/l 2 hours later. In 1 patient with a maximum plasma haemoglobin concentration of 2.5 g/l there was a slight increase in serum creatinine concentration immediately postoperatively, rising from 127 μmol/l preoperatively to 147 μmol/l immediately postoperatively, but 2 hours later it had fallen to a normal level. In the remaining 7 cases there were no signs of postoperative kidney impairment. In addition there was a significant increase in serum iron and serum bilirubin 2 hours postoperatively. Our study shows that distilled water can be used as an irrigating fluid in prostatic surgery if proper attention is given to bladder pressure and the risk of influx of irrigating fluid at the end of the operation when large veins may be opened in the venous plexus close to the prostatic capsule.