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Transurethral resection of the prostate (TURP) syndrome is the result of complex changes in intravascular volume, solute, and neurophysiologic function.

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TURP syndrome has been reported after endoscopic procedures performed under irrigation:

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  • Transurethral resection of the prostrate and bladder tumors
  • Diagnostic cystoscopy
  • Percutaneous nephrolithotomy
  • Other ureteroscopic procedures
  • Endometrial ablation
  • Arthroscopy

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The acute changes in intravascular volume and plasma solute concentrations occur as a result of irrigation fluid entering the intravascular space through the prostate venous plexus or more slowly absorbed from the retroperitoneal and perivesical spaces.

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Risk Factors for TURP and Prevention Measures
Factors associated with irrigating fluid absorptionPrevention measures
  • Length of procedure
  • Limit duration of surgery to <60 min
  • Hypotonic irrigating fluid
  • Absorption >1 L of glycine solution is associated with an increased risk of symptoms (5–20% of the TURP)
  • Use isoosmotic fluids for irrigation
  • Bipolar TURP is performed using NS as irrigant
  • Intravesical pressure >30 mm Hg resulting from high irrigating pressure (governed by the height of the irrigation bag above the prostatic sinuses)
  • Limit the position of the irrigation bag to maximum 60 cm above the surgical field to minimize hydrostatic pressure of the fluid (controversial)
  • Perform TURP under low pressure irrigation (<2 kPa)
  • Number of persistently open venous prostate sinuses increases the surface area from where absorption can take place
  • Minimize exposure to open venous sinuses by careful surgical resection
  • Limit extent of bladder distension by frequent drainage of the bladder (to avoid increased absorption through open venous sinuses)
  • Maintain adequate blood pressure and therefore normal periprostatic venous pressure
  • Preferably operate on glands <45 g
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Older studies report incidence between 0.5% and 8% with a mortality of 0.2–0.8%. Newer studies have shown lower incidence rates of 0.78–1.4% with much lower mortality rates

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Syndrome can start from 15 minutes to 24 hours after procedure starts. Indicators of volume gain are:

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  • Serum sodium dilution
  • CVP trending up
  • Plasma electrolyte concentrations (lower magnesium and calcium)
  • Transthoracic impedance change
  • Weight gain

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Clinical Manifestations of TURP Syndrome
Central nervous systemCardiovascular and respiratory systemsMetabolic and renal systems
  • Restlessness
  • Headache
  • Confusion
  • Convulsions
  • Coma
  • Visual disturbances
  • Nausea, vomiting
  • Hypertension
  • Tachycardia
  • Tachypnea
  • Hypoxia
  • Frank pulmonary edema
  • Hypotension
  • Bradycardia
  • Hyponatremia
  • Hyperglycinemia
  • Intravascular hemolysis
  • Acute renal failure
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If 1% ethanol marker is added to irrigation fluids, fluid absorption during TURP can be diagnosed by measuring the ethanol concentration in the patient's breath. This technique is not used routinely.

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GA and regional anesthesia result in comparable outcomes.

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However, spinal anesthesia is the technique of choice:

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  • May reduce the risk of pulmonary edema
  • Decreases blood loss
  • Permits early detection of mental status changes
  • Reduces CVP, potentially resulting in greater absorption of irrigating fluid

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Once TURP syndrome has been detected, the ...

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