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  • Title: [Experimental studies on hemolysis in transurethral interventions].
    Author: Bichler KH, Ideler V, Zöfel P, Harzmann R.
    Journal: Urologe A; 1985 Jul; 24(4):229-33. PubMed ID: 2412327.
    Abstract:
    The question whether distilled water can be used as irrigating fluid for the transurethral electroresection has repeatedly given occasion for discussion. Price and better visibility when resecting speak in favour of its application. Haemolytic alterations, however, might occur and seem to make its application dangerous. Our own experiments in animals show that especially blood haemolised through distilled water in the bladder (a mixture of aqua dest. and haemolised erythrocytes) has a strong haemolytic effect. Intravenous instillation of distilled water leads to haemolytic processes as well, which, however, are weaker than those occurring after instillation of erythrocytes haemolised through distilled water. Solutions of Sorbitol and Manitol (e.g. Purisole) had no measurable haemolytic effect. On the basis of our examinations we can retain the fact that with massive absorption of already haemolised erythrocytes, dangerous alterations, occur. Such alterations depend on duration of resection, technique of resection and pressure conditions (use of low pressure irrigation resectoscopes or trocar irrigation). For the experienced urologic surgeon these factors might be less relevant, for the beginner, however, who might not take into consideration the facts mentioned, results could be disastrous. The use of Sorbitol- and Manitol-fluids during TUR, prevents haemolytic incidents with certainty.
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