The absorption of irrigating fluid was measured by the ethanol method every 10 minutes during the course of 700 transurethral prostatic resections. The total blood loss was also measured using a photometer method. We found that ethanol determination is a convenient method of monitoring irrigating fluid absorption in daily practice. Absorption in excess of 150 ml. was detected in 46% of the operations. The volume of irrigant absorbed increased with the weight of the removed prostatic tissue, operating time and blood loss. The uptake of fluid usually started midway through the operation. Once absorption had started, there was an 87% probability that it would continue through the next 10 minutes with the exception of the last 10 minutes of surgery, when there was a 67% probability. A sudden decrease in arterial pressure coincided with the onset of fluid absorption 3.7 times more often than expected by chance. The absorption was no different in the 114 patients with a cancerous histology, compared to those with benign prostatic hyperplasia.

Blood loss was measured with the portable HemoCue photometer and the absorption of irrigating fluid was assessed by the ethanol method during 700 transurethral resections of the prostate. The blood loss ranged between 10 and 3,825 ml (median 300 ml). The weight of the resected prostatic tissue and the operating time were independent predictors of the amount of blood lost. General anaesthesia (n = 82) and malignant histology (n = 114) were associated with a smaller blood loss. In the patients who were given regional anaesthesia (n = 618), an mean systolic blood pressure of 100 mmHg or less resulted in a smaller bleed. Large-scale irrigating fluid absorption was typically associated with a blood loss of medium size and ranged between 500 and 1,000 ml. The incidence of such absorption was negligible in the patients in whom the blood loss per gram of resectate was less than 10 ml/g. Blood loss was also measured every 10 min during the course of another 110 operations, from which 20 patients with operating times in excess of 60 min were selected. Our analysis showed that no excessive blood loss occurred after 60 min of surgery.

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The purpose of this study was to examine the relationship between the static pressure and the absorption of irrigating fluid during transurethral resection of the prostate. We measured the absorption by the ethanol method in 550 operations during which the fluid bags were placed randomly at distances of 60-65, 70-75, 80-85 or 90-100 cm above the operating table. There was no difference in the volume of irrigant absorbed at different bag heights or any association between fluid height and absorption when different ranges of fluid absorption were analyzed. This suggests that irrigant absorption cannot be prevented by placing the fluid bags at a certain height within the range of 60 to 100 cm above the operating table.