Does intraprostatic vasopressin prevent the transurethral resection syndrome?

Objective To determine whether intraprostatic vasopressin (IPVP) prevents t he transurethral resection (TUR) syndrome during prostatectomy. Patients and methods The study comprised 36 consecutive patients (mean age 68 years) with prostates clinically assessed as greater than or equal to 20 g who underwent standard transurethral prostatectomy (TURP). Ten units of vasopressin in 0.5 mt were diluted with 9.5 mt isotonic saline and injected into the prostate transrectally before TURF. Blood samples were taken befo re and immediately after TURF to measure serum sodium concentration and fre e haemoglobin levels. The TURF irrigant used was cooled, boiled water maint ained at 70-50 cmH(2)O pressure during resection. Twenty patients had alcoh ol added to the irrigant and their breath alcohol assessed at 10-min interv als during TURF. All patients had their pulse rate, blood pressure and sens orium monitored continuously, Extreme care was taken to avoid and/or identi fy capsular damage during resection. Results The mean weight of tissue resected was 36 g and the mean resection time 24 min, There was no significant change in clinical variables during T URF. in 19 patients the breath alcohol changes were insignificant, Changes in free haemoglobin were not significant. but the levels decreased after TU RF in four patients, caused by the dilution consequent on the infusion of 8 00-1000 mL isotonic saline during surgery. Serum sodium concentrations show ed only insignificant decreases, except in one patient whose breath alcohol suggested the absorption of 500 mt of irrigant. This patient's serum sodiu m concentration decreased by 9 mmol/L: 1 L of 5% dextrose was infused durin g the procedure and capsular damage was recognized early during TURP. Conclusion Insignificant volumes of irrigant entered the circulation of the patients during TURF with water irrigation and IPVP, The greatest risk fac tor for fluid entry during TURF is capsular damage. IPVP decreases bleeding and therefore improves visibility, so allowing the early identification of capsular damage. IPVP seems therefore to be of help during TURP by decreas ing bleeding and allowing insignificant volumes of irrigant to enter the va soconstricted vessels; it appears to prevent the TUR syndrome.