INTRAVENOUS INFUSION OF RESECTOL IN TRANSURETHRAL PROSTATIC RESECTION

Abstract

The absorption of irrigating fluid and the associated reaction syndrom with fluid and electrolyte changes are well known ill effects to the patient undergoing transurethral prostatic resection. The intravenous infusion of hypertonic solutions of mannitol containing electrolytes and glucose (Resectol) were investigated clinically to determine its possible protective effects in patients undergoing the procedure.
There are two types of Resectol, namely, Resectol-T and Resectol-U.
Resectol-T consists of 15 per cent mannitol solution with 5 per cent glucose, 6 per cent dextran, 0.85 per cent sodium chloride and 0.05 per cent calcium chloride.
Resectol-U consists of 5 per cent mannitol solution with 5 per cent glucose, 0.25 per cent sodium chloride and 0.02 per cent calcium chloride.
Thirty consecutive patients who underwent transui ethral prostatic resection were studied. They were given 100ml of Resectol-T for the 15- to 20-minutes period prior to transurethral prostatic resection, and another 300ml over an 1-hour period during the resecting procedure. Postoperatively, Resectol-U at the rate of 200ml per hour was given until 7 a. m. in the morning after surgery, a total of about 3, 000 to 4, 000ml.
The irrigating fluid was urigal (cytal) and the height of the irrigating fluid was 60 to 80cm from the mid bladder level in all the cases. The amount of tissue resected varied from 4gm to 46gm and the operating time was limited to 1-hour.
Serum electrolytes and BUN determinations were done immediately before surgery, immediately following, 4 hours, 8 hours and 24 hours after completion of the transurethral prostatic resection in all the cases. Urinary output via catheter was measured every hour for the first 4 hours after surgery, then every 4 hours for the first 24 hours.
Urinary output levels measured at 1-hour intervals varied from 100ml to 470ml. However the total 4-hour output volumes were comparable to 4-hour intake volumes. The Resectol-treated patients showed an average 24-hour output of 2964ml, which was 731ml less than the average intake over the same period. The ten control patients showed an average 24-hour output of 1010ml, which was 1954ml less than the Resectol-treated patients.
In the Resectol-treated series, serum sodium levels had dropped as much as 4.0meq/L on the average immediately after surgery, and gradually returned to preoperative levels within 8 hours. Serum potassium levels had also dropped as much as 0.5meq/L on the average immediately after surgery, then gradually returned to preoperative levels within 8 hours.
In the control series, however, serum potassium levels had elevated postoperatively and exceeded the normal limit as much as 0.2meq/L at the 4-hour period after resection. Whereas, serum sodium levels remained within normal limits.
Serum chlor level revealed no remarkable change in both Resectol-treated and control series.
The most remarkable merit of Resectol was noted in the changes of BUN levels. In the control series, BUN levels gradually elevated postoperatively and reached as high as 29.9mg/dl on the average at the 24-hours period, suggesting a riskyness of transurethral prostatic resection in the aged patients with impaired kidney function. On the contrary, in the Resectol-treated series, BUN levels were successfully controlled within normal limits.
There were no cases of oliguria or renal shutdown in the entire series of 40 cases. Blood pressure reading were more stable in the 30 Resectrl-treated patients compared to 10 control patients.
In conclusion, the authors think that the intravenous infusion of Resectol-T and Resectol-U administered in the manner reported in this paper is a desirable way to promote excretion of toxic materials, increase urinary output, obviate postoperative irrigations and minimize danger of postoperative renal failure.