Which of the following substances is not used as an irrigant during transurethral resection of the prostate?
Ans. is (a) i.e. Normal Saline "TUR is performed with a nonhemolytic fluid such as 1.5% glycine. Saline cannot be used because electrolytes in the irrigation fluid will dissipate the electric current used to resect the prostate." - Schwaz 8/e p1530 (not given in 9/e) During transurethral resection of prostate strips of tissue are cut from the bladder neck down to the level of veru mon tan um. This cutting is performed by a loop mounted on the hand held trigger of the resectoscope in which Diathermy current is being passed. We all know that normal saline is a very good conductor of electricity (as it contain ions - Na+ & CI ions). So if it is used while performing TURF, the diathermy current used in the procedure will cause electrolyte diassociation of normal saline and the current will not be localized in the loop and hence cutting of the tissue will not be proper. You can put up a question that the same can occur with the use of distilled water too. Distilled water can also conduct electricity-but the current used during TURP is not very strong and distilled water is not as good conductor of electricity as Normal saline. (You must be aware that distilled water is a worse conductor of electricity than normal water.) There were also arguments that distilled water causes fluid overload and therefore should not be used in TURP. True, distilled water causes fluid overload or TURP syndrome but this complication is not common Distilled water is being replaced by 1.5% glycine but still can be used for TURP (and is used in many centres when glycine is not available) Do not get confused by what is written in Bailey 241" /e p. 1377, 1378 (23/e, p1245, 1246) - If you go through it carefully, you will find that Bailey states that normal saline is used after the operation i.e. it is used for post operative irrigation.
Normal Saline
1.5% Glycine
5% Dextrose
Distilled Water