INTRAVENOUS INFUSION OF RESECTOL IN TRANSURETHRAL PROSTATIC RESECTION

Abstract

Mannitol as an agent for intravenous drip use in transurethral resection was first reported by Henry Bodner in 1964. It was subjected to considerable modifications by us on the basis of our results obtained through our experiences, and two types of mannitol solution, namely Resectol-T and -U have been prepared.
Resectol-T contains 15% mannitol, 5% glucose, 3% dextran, 0.85% sodium chloride and 0.05% calcium chlorides. We administered 100ml of it by intravenous drip in 15 to 20 minutes just before transurethral resection and 300ml over approximately 60 minutes during the resections This is prepared as a hypertonic solution so as to cope with rapid absorption of irrigating fluid which may occur during the resecting procedure.
Resectol-U, on the other hand, is composed of 5% mannitol, 5% glucose, 0.25% sodium chloride and 0.02% calcium chloride. We administered this solution continuously from immediately after transurethral resection up to 7 a. m. next morning at the rate of 200ml per hour to promote urinary excretion and elimination of toxic substances produced during the resecting procedure as well as to correct abnormal shift of serum electrolytes.
Eighty cases of transurethral prostatic resection were subjected in this study and their detailed data through preoperative and postoperative period were obtained and analyzed.
The fluid intake during 24 hours following transurethral prostatic resection averaged 3, 443ml, while the urinary output during the same period was 3, 133ml on the average, which is about three times as much as that of the control group.
The blood urea nitrogen levels in the control group apparently elevated in most of the cases. In the Resectol-treated group, on the contrary, quite favorable results were obtained; showing apparent downward tendency postoperatively, the average being lowered from 14.9mg/dl to 809mg/dl in 24 hours after resection.
The serum sodium levels in the Resectol-treated group remained generally within the normal range and returned to almost the preoperative level in 24 hours postoperatively. The serum potassium levels in the control group tended to increase postoperatively up to average of 5.7mEq/L, at the 4th hour, whereas the Resectol-treated group showed no gross changed The serum chlor and calcium levels showed no important change in clinical standpoint.
The amount of mannitol excreted in urine in 24 hours after resection was approximately 41% of the administered dose, and 47% in 48 hours after resection. This indicates that about 53% of the administered dose is still remaining in the extracellular fluid at 48th postoperative hour.
Sodium of Resectol was excreted in an amount nearly proportional to that of mannitol, approximately 68.8% of the administered dose being excreted in 24 hours.
Potassium, though it is not contained in Resectol, is excreted in considerably large quantity of 55.4mEq in 24 hours, whereas serum potassium showed rather an upward tendency postoperatively.
Urinary excretion of chlor was approximately 81.0% and calcium was 57.5% of the each administered dose.
In the Resectol-treated group, a tendency of mild metabolic acidosis was observed in the immediate postoperative period and then a tendency of mild respiratory alkalosis in 24 hours postoperatively.
These results are satisfactory enough to place all the more reliance upon Resectol, and I believe that this method may make an epoch in preventing transurethral resection reaction.