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.