Irrigation with water during transurethral resection of the prostate (TURP) induces intravascular hemolysis

Background: The transurethral resection syndrome TUR syndrome is the most serious complication following transurethral resection of prostate (TURP).

Objective: We compared 5% dextrose in water with sterile water as an irrigating solution and evaluated postoperative intravascular hemolysis.

Methods: A prospective, randomized, controlled trial of 41 benign prostatic hypertrophy (BPH) patients who underwent TURP. The differences between preoperative and postoperative free plasma hemoglobin were measured by using a spectrophotometric method to determine the degree of intravascular hemolysis. Serum glucose and electrolytes were measured preoperatively and postoperatively. Signs and symptoms of TUR syndrome were recorded. Prostatic tissues were weighed. Volumes of irrigating fluid were recorded.

Results: Free plasma hemoglobin was significantly increased in the sterile water group (n = 21) and higher than in the 5% dextrose in water group (n = 20) (p < 0.001). The postoperative plasma glucose was higher in the 5% dextrose in water group (p = 0.007). None of patients developed a TUR syndrome. There was no difference in other serum electrolytes between both groups.

Conclusion: Intravascular hemolysis can be prevented by using 5% dextrose in water instead of sterile water. No correlation between hemolysis and TUR syndrome was found in TURP patients with postoperative stable serum sodium.