This study showed that both balanced 6% HES 130/0.4 (Tetraspan) and saline-based 6% HES 130/0.4 were equally effective for hemodynamic stabilization of patients undergoing major urologic procedures without any significant impact on acid base or renal functions. In the context of safety concerns that has been raised recently regarding the use of HES in critically ill patients, it is time to reevaluate the safety of using HES intraoperatively and whether we still need to continue using these solutions or not the third generation of tetrastarches shows a significantly improved safety profile without any loss of volume effect compared to first- and second- generation HES preparations.