The value of frusemide in 110 consecutive prostatectomies

Abstract

SUMMARYOne hundred and ten patients undergoing open prostatectomy had an induced diuresis using frusemide. The results of this treatment are reviewed. Seventy-one patients (65 per cent) presented as emergencies with acute retention, while the remainder presented with chronic retention or prostatism. The average age was 69 years, and 25 patients (23 per cent) were aged 75 years or more. Only rarely was a patient refused operation because of confinement to bed or failing mental faculties. Blood-loss, fluid and electrolyte balance, and postoperative urinary infection were studied in detail, and the following points are emphasized :-I . The average postoperative ~+hour urinary output was 4.5 litres, 40 per cent of which was passed in the first 3 hours when the danger of clot retention is greatest.2. Clot retention was eliminated as a problem, and bladder wash-outs were not necessary.3. The average blood replacement was 1.05 U., and the average fall in postoperative haemoglobin level was 1.1 g.4. The postoperative urinary infection rate was low, being 8 per cent at I week after operation.5. A low morbidity was recorded and the mortality was 0.9 per cent.A vigorous diuresis induced by frusemide after suitable fluid loading is both effective and safe. It is a distinct advance over previous methods used. THE immediate complication after prostatectomy is haemorrhage, and its possible sequel, clot retention. In general, the threat of this complication is present only in the first few hours after operation. The other important complication, urinary infection, is potentiated by excessive bleeding and poor bladder drainage necessitating interference with the catheter. Any method which ensures a free flow of urine will reduce these hazards. A large urinary secretion will dilute and prevent the clotting of blood that is being shed in the immediate postoperative period. Also, by removing the environment which is favourable to bacterial growth, urinary infection may be prevented.Osmotic diuretics have been extensively used in prostatic surgery. McKelvie in 1962 and Rickwood and Thorne in 1967 reported good results using intravenous urea. Jameson in 1969 described the use of mannitol and intramuscular frusemide in 80 cases. Recently, Essenhigh and Eustace (1969) have described the use of frusemide administered intravenously in a larger dose in a series of 50 cases.