The use of low-viscosity fluids for hysteroscopy.

We reviewed the literature addressing the use and complications associated with low-viscosity distention fluids in urologic and hysteroscopic procedures. The possible causes of fluid complications included elevated intrauterine pressure, myometrial invasion, prolonged operating time, and operative trauma to the cervix or uterine body. Physiologic electrolyte solutions create only fluid overload, and treatment requires cardiovascular support and diuresis. Nonelectrolytic solutions result in acute dilutional hyponatremia, which has been referred to as the transurethral resection of the prostate syndrome. Treatment requires diuresis and a rapid, controlled return of the serum sodium level to 120-130 mmol. These complications can be minimized with proper use of equipment and careful monitoring of fluid volumes. To recognize and treat them, the surgeon must be knowledgeable about the fluid being used and the difficulties it may cause.