Urological Emergencies in Clinical Practice стр.113

148 H. HASHIM AND J.REYNARD

and fluid restriction, without going on to develop the more serious manifestations of advanced TUR syndrome.

Dilutional hyponatraemia is the most important and serious factor leading to the symptoms and signs. The serum sodium usually has to fall to below 125 mmol/L before the patient becomes unwell. The hypertension is due to fluid overload. Visual disturbances may be due to the fact that glycine is a neuro-transmitter in the retina.

Definitive Treatment of the TUR Syndrome

Send a sample of blood to the lab for sodium measurement, and give 20 to 40 mg of intravenous frusemide to off-load the excess fluid that has been absorbed.

DISPLACED CATHETER POST-RADICAL PROSTATECTOMY

Urethral catheters are left in situ post-radical prostatectomy for a variable time depending on the surgeon who performs the operation. Some surgeons leave a catheter for 3 weeks and others for just 1 week. Thus, if a catheter falls out a week after surgery, the patient may well void successfully, and in this situation no further action need be taken.

If, however, the catheter inadvertently falls out the day after surgery, we would make a gentle attempt to replace it with a 12-Ch catheter that has been well lubricated. If this fails, we would pass a fleixble cystoscope, under local anaesthetic, into the bulbar urethra and attempt to pass a guidewire into the bladder, over which a catheter can then safely be passed. If this is not possible, another option is to hope that the patient voids spontaneously, and does not leak urine at the site of the anastomosis. An ascending urethrogram may provide reassurance that there is no leak of contrast and that the anastomosis is watertight. If there is a leak or the patient is unable to void, a suprapubic catheter could be placed, either percutaneously or under general anaesthetic via an open cystostomy.

COMPARTMENT SYNDROME OF THE LOWER LIMB ASSOCIATED WITH THE LITHOTOMY POSITION

Lower limb compartment syndrome (LLCS) is the development of an increased tissue pressure within the closed osteofascial compartment of the leg, which reduces perfusion of the leg leading to ischaemia of the muscles and nerves. If prolonged, it leads to permanent loss of function in the affected muscles and nerves. In the context of urological surgery LLCS is specifically associated with the lithotomy position and is said to occur with


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