FLUID ABSORPTION AND CIRCULATING ENDOTOXINS DURING TRANSURETHRAL RESECTION OF THE PROSTATE

Recent publications report increased cardiovascular morbidity and mort ality after transurethral prostatic resection (TURP). Repeated breath- ethanol monitoring with a new infrared device permits a highly sensiti ve peroperative registration of fluid absorption. A prospective study in 52 patients revealed surprisingly high rates of intravascular fluid loads without clinical manifestations. Only 4 patients developed clin ical signs of the TUR syndrome. Immunological work-up in 41 patients d emonstrated circulating endotoxins and significant rise of endogenous tumour necrosis factor (TNF) in 3 of these patients. In 11 patients tr ansient endotoxins could be detected during resection under prophylact ic parenteral antibiosis. In the face of less invasive approaches to b enign prostatic hyperplasia, close intraoperative monitoring and antib iotic coverage should be demanded as a routine procedure during TURP. Elective surgery should be delayed until appropriate antibiotic therap y has been given.