What is the irrigation fluid estimate per resection time for a Transurethral Resection of the Prostate (TURP) procedure?

Irrigation Fluid Estimate per Resection Time for TURP

The irrigation fluid estimate for Transurethral Resection of the Prostate (TURP) procedures averages approximately 68.7 liters, with a range from 5.0 to 174.0 liters depending on prostate size, resection time, and surgical technique. 1

Factors Affecting Irrigation Fluid Requirements

• The amount of irrigation fluid used during TURP shows an inverse correlation with resection rate (grams of prostate resected over time), indicating that more skilled operators typically use less irrigation fluid 2
• Larger prostate adenomas require more irrigation fluid, showing a direct correlation between adenoma weight and total irrigation volume 2
• Continuous flow irrigation techniques are associated with higher fluid absorption rates compared to intermittent flow techniques 3
• The type of anesthesia affects fluid absorption - spinal anesthesia is associated with significantly higher irrigation fluid absorption compared to general anesthesia with positive pressure ventilation 4

Irrigation Fluid Estimates Based on Procedure Variables

• For standard monopolar TURP procedures:

  • Average irrigation volume: 68.7 liters (range: 5.0-174.0 liters) 1
  • Irrigation requirements increase with longer resection times and larger prostate volumes 2, 1

• For bipolar TURP procedures:

  • Generally requires similar irrigation volumes to monopolar TURP, but with potentially lower absorption risks 5
  • Bipolar TURP has a more favorable perioperative safety profile than monopolar TURP, partly due to different irrigation fluid requirements 5

Clinical Implications and Monitoring

• Higher irrigation fluid usage correlates with:

  • Increased intraoperative bleeding 2
  • Longer postoperative bladder irrigation time 2
  • Extended catheterization duration 2

• Fluid absorption risks increase when:

  • Intravesical pressure exceeds 10-25 cm H₂O (1.0-2.5 kPa) 3
  • Resection time exceeds 20 minutes with continuous absorption 6
  • Central venous pressure is lower (as seen in spinal anesthesia) 4

Practical Recommendations for Fluid Management

• During TURP procedures, maintain crystalloid administration at 1-4 ml/kg/hr as maintenance fluid 7
• For patients developing intravascular volume deficits, administer goal-directed fluid boluses (200-250 ml) to treat objective evidence of hypovolemia 7
• Regular monitoring of vital signs, urine output, and fluid balance is essential during the procedure 7
• Consider more advanced hemodynamic monitoring for longer procedures or higher-risk patients 7

Pitfalls and Complications

• Excessive fluid absorption can lead to TURP syndrome, with initial hypervolemia and electrolyte disturbances within the first 20 minutes, followed by potential hypovolemia and hypotension 6
• Patients with lower blood loss during TURP are paradoxically at higher risk for hypertension and chest pain when absorption occurs 6
• Avoid excessive fluid administration, as this can lead to fluid overload and pulmonary edema, especially in patients with cardiac or renal comorbidities 7