Irrigation fluids and their hazards

Abstract

Fluids are infused into the urinary tract during endoscopic urology to distend the viscus and to wash away any blood and improve the view. All bladder irrigants should be pyrogen free and used as close to body temperature to minimize heat loss during surgery. The commonest fluid used in the UK is isotonic saline, but for monopolar prostatic resection, a nonionic liquid that does not conduct electricity is required. A variety of solutions have been used including water, glycine, sorbitol, and mannitol. All, except water, are weakly hypotonic, thereby reducing the risk of intravascular hemolysis which remains a significant risk when using water. Glycine (1.5%) is currently the most widely used fluid used for this purpose, but water continues to be used in some parts of the world, primarily for economic reasons. While glycine is well suited to monopolar resection, there are hazards with its use, most notably intravascular absorption with the development of the so-called TUR syndrome.