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Anesthesiology

TURP syndrome

Transurethral resection of prostate (TURP) syndrome is a systemic complication of transurethral resection of the prostate or bladder tumours, caused by excessive absorption of electrolyte-free irrigation fluids.

Introduction

Transurethral resection of prostate (TURP) syndrome is a systemic complication of transurethral resection of the prostate or bladder tumours, caused by excessive absorption of electrolyte-free irrigation fluids.

  • The role of irrigation solution is to distend the bladder, clear the surgical site and wash away resected tissue and blood.

Clinical features

It comprises acute changes in intravascular volume, plasma solute concentrations, and osmolality, and direct effects of the irrigation fluid used (glycine and its metabolites in the UK, as glycine 1.5% is the most common irrigation fluid used). The effects are proportional to the volume of irrigating solution absorbed. The presentation is not always uniform, and milder cases may be unrecognized.

The clinical spectrum ranges from asymptomatic hyponatremia to electrocardiographic changes, nausea, vomiting, convulsions, coma, alterations of vision, pulmonary edema, cardiovascular compromise and death.


Management

If TURP syndrome is suspected, surgery must be abandoned as soon as possible and i.v. fluids stopped.

  • Respiratory support (if necessary, with intubation and ventilation) and the circulation.
  • Bradycardia and hypotension should be treated with atropine, adrenergic drugs, and i.v. calcium.
  • I.V. anticonvulsants (e.g. diazepam or lorazepam) should be used to control seizures and i.v. magnesium therapy considered, if seizures prove difficult to control.
  • Blood should be obtained and checked for sodium, osmolality, and haemoglobin.
Management of severe TURP syndrome. | Aidan M. O’Donnell, BSc MB ChB FRCA, Irwin T.H. Foo, MB BChir MD MRCP(UK) FRCA, Anaesthesia for transurethral resection of the prostate, Continuing Education in Anaesthesia Critical Care & Pain, Volume 9, Issue 3, June 2009, Pages 92–96, https://doi.org/10.1093/bjaceaccp/mkp012

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