Life-threatening transurethral resection syndrome despite monitoring of fluid absorption with ethanol.

Ethanol monitoring is a fairly new method for assessing fluid absorption during transurethral resection of the prostate. The volume of irrigant absorbed is usually estimated from a nomogram every 10 min during the operation. We report a case in which a patient developed a transurethral resection syndrome and circulatory shock despite ethanol monitoring and adequate volume replacement. The further course of the operation showed that absorption had occurred by the extravascular route. In these cases, ethanol monitoring can be misleading as the maximum breath ethanol level occurs after a delay of 20 min and the fluid absorption is three times larger than indicated by the nomogram.