Should Dytor (Torsemide) Be Continued for Transurethral Resection of the Prostate?
Continue torsemide through the morning of surgery and resume it orally as soon as possible postoperatively, as loop diuretics should be maintained in heart failure patients throughout the perioperative period to prevent decompensation. 1
Perioperative Management of Loop Diuretics
The European Society of Cardiology explicitly recommends that diuretics be continued in heart failure patients up to the day of surgery, resumed intravenously perioperatively if needed, and continued orally when possible. 1 This is a Class I recommendation with Level C evidence, reflecting the critical importance of maintaining volume control in heart failure patients even during surgical procedures. 1
Why Continue Torsemide for TURP?
TURP is an intermediate-risk procedure where maintaining heart failure control outweighs theoretical perioperative concerns. 1
Stopping diuretics risks acute decompensation with fluid retention, pulmonary edema, and worsening heart failure symptoms during the perioperative period when fluid shifts occur. 1
Torsemide's pharmacokinetic profile makes it particularly suitable for perioperative use, with its 12-16 hour duration of action providing sustained diuretic effect even if a single dose is delayed. 1, 2
Practical Implementation
Give the usual morning dose of torsemide on the day of surgery with a small sip of water, as this maintains therapeutic levels throughout the procedure. 1
Monitor for volume status and electrolytes closely in the immediate postoperative period, checking potassium and sodium within 24-48 hours after surgery. 2
Resume oral torsemide at the home dose as soon as the patient tolerates oral intake, typically within hours after TURP. 1
If oral intake is delayed beyond 12-24 hours, consider intravenous furosemide at twice the oral torsemide dose (e.g., torsemide 10 mg oral = furosemide 40 mg IV) to maintain diuresis. 2
Key Differences from Hypertension-Only Patients
This recommendation differs critically from patients taking diuretics solely for hypertension, where the European Society of Cardiology states that low-dose diuretics for hypertension can be discontinued on the day of surgery. 1 However, in heart failure patients, diuretics are essential for volume management and must be continued. 1
Common Pitfalls to Avoid
Do not hold torsemide out of concern for hypotension or mild azotemia, as the American College of Cardiology warns that excessive concern about these parameters leads to underutilization of diuretics and refractory edema. 2
Do not confuse TURP with major vascular or cardiac surgery, where more extensive perioperative medication adjustments may be warranted. 1
Ensure electrolytes are optimized preoperatively, particularly potassium >4.0 mEq/L and magnesium >2.0 mg/dL, as the European Society of Cardiology recommends correcting electrolyte disturbances before surgery. 1
Watch for excessive fluid administration during TURP, as irrigation fluid absorption can occur; maintaining diuretic therapy helps manage this risk. 1
Monitoring Parameters
Daily weights at the same time on the same scale, targeting stable weight perioperatively. 2
Blood pressure before each dose, ensuring systolic BP ≥90-100 mmHg. 2
Electrolytes (sodium, potassium) checked within 24-48 hours postoperatively. 2
Urine output monitored to ensure adequate diuresis resumes postoperatively (target >0.5 mL/kg/hour). 2