Benign hypertrophy of the prostate (BPH) is a disease seen in 20% of men over the age of 50
and in 40% of those over the age of 70. The gold standard in the treatment of BPH is
transurethral resection of the prostate using high-frequency diathermy. Today, this process
is done with the bipolar technique, in which normal saline (isotonic sodium chloride %0.9) is
used as the irrigation fluid. In bipolar TUR-P, resection is performed using 25000 - 30000 ml
normal saline for irrigation. This irrigation fluid, which is used after long operation and
deep tissue resection, can enter the systemic circulation through the opened venous sinuses.
It has been shown in clinical studies that postoperative acute hyperchloremia (serum Cl level
> 110 mmol/L) develops after the use of intravenous normal saline solution in large amounts
in the perioperative period. McCluskey et al. found that 30-day mortality, prolonged hospital
stay, and postoperative renal dysfunction developed in patients who received perioperative
intravenous normal saline and subsequently developed acute hyperchloremia. Megan E. et al.
Scheingraber et al. reported that the use of normal saline increases the risk of acidosis and
kidney damage, also compared Ringer's lactate and normal saline infusion in patients who
underwent gynecological surgery and showed that hyperchloremic metabolic acidosis developed
in normal saline group. Excessive and rapid administration of normal saline solution by
parenteral route causes hyperchloremic metabolic acidosis, which adversely affects the
organism. According to recent studies, the development of hyperchloremic metabolic acidosis
increases the cost and mortality, prolongs the hospitalization period, and causes renal
dysfunction.
Our aim is to detect hyperchloremia and associated metabolic acidosis without anion gap in
the follow-up of these patients. Our primary hypothesis in this study is that hyperchloremic
metabolic acidosis will develop due to the high amount of normal saline used in TUR-P.
The investigators expect that an increase in the amount of fluid, prolongation of the
operation time, and capsule perforation will increase hyperchloremia and deepen metabolic
acidosis. If it causes hyperchloremic metabolic acidosis, the contribution of the amount of
irrigation fluid or the duration of the operation can be determined, and the maximum amount
of fluid that does not adversely affect the organism and the duration of the operation can be
predicted.
