IT HAS BEEN suggested that the clinical syndrome of restlessness, confusion, nausea, vomiting, bradycardia, and hypertension occurring during or immediately after transurethral resection of the prostate is caused by hypotonicity secondary to absorption of irrigation water. Intravenous administration of hypertonic solutions such as 5% saline, 30% urea, or 25% mannitol has been advocated to prevent or reverse the process. This syndrome, and its relation to hypotonicity, was investigated in a double-blind study using intravenous fluid replacement therapy and sterile water irrigation in 14 consecutive electroresections of the prostate. Serial measurements of blood volume, serum electrolyte, and solute concentrations were performed before and after surgery, and the patients' subjective as well as objective responses carefully noted.
Consecutive transurethral procedures with sterile water irrigation were performed in 14 men, 20 to 79 years of age. Spinal anesthesia was used. Most operations were resections for benign prostatic hypertrophy. Intravenous fluid replacement therapy,