Post-TURP Fluid Replacement: Isotonic Saline is the Fluid of Choice
Normal saline (0.9% NaCl) is the fluid of choice for replacement post-Transurethral Resection of the Prostate (TURP) due to its safety profile and reduced risk of complications compared to other fluids. 1
Irrigation and Replacement Fluid Considerations
Bipolar vs. Monopolar TURP
- Bipolar TURP uses isotonic saline (0.9% NaCl) as irrigation fluid, which significantly reduces the risk of TUR syndrome compared to glycine 1.5% used in monopolar TURP 2
- Bipolar TURP is associated with a smaller decline in serum sodium levels (1.5 mmol/L) compared to monopolar TURP (2.5 mmol/L), making isotonic solutions safer for both irrigation and replacement 2
TUR Syndrome Risk
- TUR syndrome is a potentially serious complication characterized by dilutional hyponatremia due to absorption of irrigation fluid during TURP 3
- In a randomized trial comparing irrigation fluids, all 17 cases of TUR syndrome occurred in patients where glycine 1.5% was used, with none occurring in saline or glucose groups 4
- Isotonic saline prevents the development of classical TUR syndrome, though volume overload can still occur 5
Post-TURP Fluid Management Protocol
Immediate Post-Operative Period
- Maintain crystalloid administration at 1-4 ml/kg/hr using isotonic saline as the primary replacement fluid 6
- For patients developing intravascular volume deficits, administer goal-directed fluid boluses (200-250 ml) of isotonic saline 1
- Monitor vital signs, urine output, and fluid balance regularly to detect early signs of volume overload 1
Special Considerations
- For longer procedures (>1 hour) where significant fluid absorption may have occurred, more careful monitoring is required as the difference in sodium levels becomes more significant with longer operation times 2
- In cases with significant bleeding (transfusion rate approximately 8% in TURP), isotonic saline is preferred to maintain hemodynamic stability without risking electrolyte imbalances 1
Alternative Fluids and Their Limitations
- Glucose 5% solution can cause transient hyperglycemia (170 ± 35.9 mg/dl) and hypokalemia (3.67 ± 0.92 mmol/L) in the immediate postoperative period 4
- Glycine 1.5% is associated with higher rates of TUR syndrome and should be avoided for replacement 4
Monitoring Parameters
- Serum sodium levels should be monitored, particularly in cases where glycine was used as irrigation fluid 2
- For bipolar TURP using saline irrigation, routine repeated serum analysis of electrolytes can be omitted 2
- When using isotonic saline for both irrigation and replacement, monitor for signs of iso-osmolar volume overload, which can still occur in up to 9% of cases 5
Transition to Oral Intake
- Encourage early oral fluid intake after the procedure when the patient is stable 1
- Discontinue intravenous fluids once adequate oral intake is established 1
Normal saline remains the safest option for post-TURP fluid replacement, minimizing the risk of electrolyte disturbances while providing adequate volume replacement.