From the Guidelines
TURP syndrome is a potentially life-threatening complication that can be minimized by using bipolar resection techniques, which have a reduced risk of hyponatremia and TUR syndrome, as stated in the 2018 AUA guideline 1.
Prevention and Management
To prevent TURP syndrome, it is essential to limit resection time, use bipolar resection techniques, maintain irrigation bag height below 60 cm, and use isotonic irrigation solutions like glycine 1.5% 1.
- Limiting resection time to under 60 minutes can help reduce the risk of TURP syndrome.
- Using bipolar resection techniques can minimize the risk of hyponatremia and TUR syndrome.
- Maintaining irrigation bag height below 60 cm can help reduce the amount of irrigation fluid absorbed into the bloodstream.
- Using isotonic irrigation solutions like glycine 1.5% can help prevent dilutional hyponatremia.
Treatment
If TURP syndrome occurs, management involves immediate recognition, stopping the procedure, supporting vital functions, and correcting electrolyte imbalances 1.
- Administering hypertonic saline (3% NaCl) at 100-200 mL over 10-15 minutes for severe hyponatremia (sodium <120 mEq/L) can help correct electrolyte imbalances.
- Furosemide 20-40 mg IV may be given to promote diuresis.
- Oxygen therapy, ventilatory support if needed, and treatment of seizures with benzodiazepines are essential.
Pathophysiology
TURP syndrome occurs because hypotonic irrigation fluid enters the circulation through open prostatic venous sinuses, causing dilutional hyponatremia and fluid overload 1.
- The absorption of irrigation fluid can lead to a rapid decrease in sodium levels, causing confusion, nausea, vomiting, hypertension followed by hypotension, bradycardia, and visual disturbances.
- Prompt recognition and treatment are crucial as mortality can reach 25% if severe hyponatremia develops rapidly.
From the Research
Definition and Causes of TURP Syndrome
- TURP syndrome is a complication that can occur during or after transurethral resection of the prostate (TURP) surgery 2, 3.
- The syndrome is caused by the absorption of irrigating fluid used during the surgery, leading to hypervolemia, hyponatremia, and other electrolyte imbalances 3, 4.
- The absorption of irrigating fluid can cause a range of symptoms, including hypotension, bradycardia, and hypertension 3.
Risk Factors and Prevention
- The risk of TURP syndrome can be reduced by using prophylactic hypertonic saline (HS) during TURP surgery 2.
- A low dose of HS (2 mL.kg-1.h-1) has been shown to be effective in preventing TURP syndrome without causing adverse effects or hypernatremia 2.
- The use of bipolar saline TURP has also been shown to eliminate the risk of TURP syndrome in high-risk patients with large prostates 5.
Treatment and Management
- Treatment of TURP syndrome typically involves correcting the electrolyte imbalance and managing the symptoms 3, 6.
- Hypertonic saline solution can be used to treat hyponatremia, but it must be administered with caution to avoid severe neurologic adverse effects 6.
- Other treatment options for hyponatremia include loop diuretics, fluid restriction, and pharmacologic agents such as demeclocycline and lithium carbonate 6.
- Newer treatments, such as arginine vasopressin (AVP) receptor antagonists, are being developed for the treatment of hyponatremia 6.