Fluid Management During Cystoscopy and TURP Procedures
For cystoscopy and TURP procedures, patients should receive crystalloids at a rate of 1-4 ml/kg/hr to maintain homeostasis, with additional goal-directed fluid boluses (200-250 ml) to treat objective evidence of hypovolemia. 1
Preoperative Considerations
- Patients should arrive for anesthesia in a euvolemic state with any preoperative fluid and electrolyte imbalances corrected 1
- Current anesthetic recommendations allow patients to eat up to 6 hours and drink clear fluids up to 2 hours prior to anesthesia, helping prevent preoperative fluid depletion 1
- Some patients may require intravenous fluids to restore euvolemia before surgery 1
Intraoperative Fluid Management
- During TURP and cystoscopy procedures, most patients require crystalloids at a rate of 1-4 ml/kg/hr as maintenance fluid 1
- Balanced crystalloid solutions (e.g., Hartmann's solution) are preferred over normal saline to reduce complications 1, 2
- For patients developing intravascular volume deficits, administer goal-directed fluid boluses (200-250 ml) to treat objective evidence of hypovolemia (>10% fall in stroke volume) 1
- Monitor for TURP syndrome (dilutional hyponatremia), which occurs in <1% of cases but represents a potentially life-threatening complication 3, 4
Special Considerations for TURP
- TURP procedures carry a risk of significant fluid absorption through prostatic venous sinuses, potentially leading to TURP syndrome 3, 4
- Larger prostates (>50 ml) are associated with longer operative times and increased risk of bleeding and fluid absorption 3, 5
- The risk of bleeding requiring transfusion during TURP is approximately 8%, which may necessitate additional fluid management 3
- If signs of TURP syndrome develop (hyponatremia, confusion, visual disturbances), immediately cease the procedure and correct electrolyte abnormalities 3, 4
Monitoring During Procedure
- Regular monitoring of vital signs, urine output, and fluid balance is essential 1
- For longer procedures or higher-risk patients, consider more advanced hemodynamic monitoring to guide fluid therapy 1
- Monitor serum sodium levels, especially during prolonged procedures or when large volumes of irrigation fluid are used 3, 4
Postoperative Management
- Encourage early oral fluid intake after the procedure 1
- Discontinue intravenous fluids once adequate oral intake is established 1
- Monitor for complications such as bleeding (8% risk of requiring transfusion), urinary tract infections (6%), and bladder neck contracture/urethral stricture (7%) 3, 6
Pitfalls and Caveats
- Avoid excessive fluid administration, as this can lead to fluid overload and pulmonary edema, especially in patients with cardiac or renal comorbidities 1, 2
- Be vigilant for signs of TURP syndrome, particularly during prolonged procedures or when operating on large prostates 3, 4
- The efficiency of fluid distribution may change based on patient physiological conditions (e.g., general anesthesia, surgery, stress, dehydration, blood pressure, or inflammation) 2
- In cases of bladder perforation during the procedure, immediately place a large-caliber urethral catheter (20-24 Fr) with continuous bladder drainage 7