A number of
irrigants are used in the genitourinary system during urologic procedures.
These include irrigants used to dissolve stones, that is, renacidin, Suby’s
Solution G, and irrigants used for endoscopic procedures, which include water,
glycine, sodium chloride, sorbatol, and urea. Each one of these irrigants may
have significant untoward effects particularly if excessive absorption occurs.
With the use of
renacidin or Suby’s Solution G, magnesium intoxication may occur with increased
salivation followed by hypotension, seizures, and coma. It is particularly dangerous
to utilize these solutions in the presence of infection as sepsis may be a sequelae.
The use of
water, glycine, sorbatol, and urea as irrigants may result in volume overload
and severe hyponetremia—termed the transurethral resection syndrome.
Significant volume overload
results in an
increased pulse pressure, bradycardia and in the case of severe hyponetremia, visual
disturbances followed by seizures, coma, and death. The correction of these
abnormalities, if hyponetremia is a major component, includes diuresis with
restoration of systemic sodium. In severe cases of hyponatremia in patients who
are symptomatic, half of the sodium deficit is replaced with hypertonic saline.
It should be noted that diuretics do not work in patients with severe
hyponetremia. Therefore, repletion may be necessary before a loop diuretic is
effective.
The use of
saline as an irrigant results in volume overload and volume expansion without
hypernatremia. A diuretic and fluid restriction are therapeutic.
On occasion
ammonium intoxication may occur with the use of glycine.
Prevention of
untoward long-term sequelae is best accomplished by recognition of the
potential problems and correcting the metabolic abnormalities early, even
though they may be of minor degree.
