Maintenance Fluid of Choice in Immediate Post-Operative Period of TURP
Recommended Maintenance Fluid
Isotonic balanced crystalloid solutions are the maintenance fluid of choice in the immediate post-operative period following TURP. 1
Rationale for Balanced Crystalloid Solutions
- Balanced crystalloid solutions (such as lactated Ringer's) are more physiological than 0.9% sodium chloride and help avoid hyperchloremic metabolic acidosis 2
- Balanced solutions provide electrolyte composition closer to plasma, containing additional electrolytes like potassium, magnesium, and calcium 3
- Using balanced solutions reduces the risk of post-operative hyperchloremia and metabolic acidosis that can occur with non-buffered solutions like normal saline 3
Fluid Administration Guidelines
- Maintain crystalloid administration at 1-4 ml/kg/hr as maintenance fluid during the immediate post-TURP period 1
- Goal-directed fluid therapy should be used for patients developing intravascular volume deficits 1
- Avoid excessive fluid administration to prevent fluid overload and pulmonary edema, especially in patients with cardiac or renal comorbidities 1
Special Considerations
- Regular monitoring of vital signs, urine output, and fluid balance is essential during the immediate post-operative period 1
- Consider more advanced hemodynamic monitoring for higher-risk patients or those with significant comorbidities 1
- Bipolar TURP has a more favorable perioperative safety profile than monopolar TURP, partly due to different irrigation fluid requirements, but maintenance fluid recommendations remain the same 2, 4
Potential Complications to Monitor
- TUR syndrome: Though less common with bipolar TURP, still monitor for signs of hyponatremia, confusion, and cardiovascular instability 2, 4
- Bladder perforation: If suspected during TURP, place a large-caliber urethral catheter (20-24 Fr) with continuous drainage 5
- Failure to void: Up to 12% of patients may fail to void after TURP on initial catheter removal, with higher rates (38-44%) in those with chronic or acute-on-chronic retention 6
DVT Prophylaxis Considerations
- TURP is generally considered a low-risk procedure for DVT with incidence rates of symptomatic VTE within 91 days of only 0.3-0.5% 7
- For low-risk patients, early ambulation alone is sufficient 7
- For moderate to high-risk patients, consider mechanical prophylaxis with intermittent pneumatic compression or graduated compression stockings 7
- Pharmacologic prophylaxis should be used cautiously due to increased risk of bleeding in TURP patients 7
Evidence Quality Assessment
- The evidence supporting balanced crystalloid solutions over normal saline is of moderate quality 3
- Studies show measurable biochemical benefits with buffered fluids, particularly significant reduction in postoperative hyperchloremia and metabolic acidosis 3
- Limited high-quality evidence specifically addressing maintenance fluid choice post-TURP, but general perioperative fluid management principles apply 1, 3