1. Complications of TURP 1. Case presentation 2. TURP syndrome
3. Prevention and treatment
Ri 陳昭勳

2. Brief History 陳X傑 63y/o male Symptoms of urinary frequency and urgency
OPD follow-up and controlled by Hytrin

3. Past History Coronary artery disease s/p stenting
controlled by Aspirin
Hypertension controlled by Norvasc
ASA Class III

4. Incidence of systemic dz in TURP patients
Disease Incidence %
Cardiac disease
Cardiovascular
COPD DM

5. Brief History 2 weeks ago difficulty in urination
Foley catheterizations several times
Cystostomy on DC Tapal
Admission for TURP on

6. 麻醉過程
Please see 實物投影機

7. Irrigation Solution
Ideal: isotonic, electrically inert, nontoxic, transparent, easy to sterilize,inexpensive
Traditional: distilled water
Modern: Glycine (1.2% and 1.5)
Mannitol ( 3%)
Urea ( 1%)

8. Definition of TURP syndrome
Following complications have been reported: hypervolemia, hyponatremia,
water intoxication, pulmonary
edema, hemolysis,
caogulopathy, bladder perforation

9. TURP syndrome: a problem of Volume and Solute
Intravascular volume: volume
expansion and volume loss
Plasma solute: hyponatremia
hypoosmolality
hyperglycinemia
Plasma osmolality=2xNa+Glu/18+BUN/2.8

10. Hyponatremia Mechanism for hyponatremia in TURP
Na is essential for cerebral and cardiac function
<120 meq/L cardiovascular depression
<115meq/L bradycardia,ECG change
<100meq/L generalized seizure
Average fall in Na meq/L
Incidence 7%-26%

11. Hypoosmolality Derangement of CNS function due to cerebral edema
Clinical signs: decerebrate posture, positive Babinski sign, low-voltage EEG, comatose

12. Hemolysis 30-70% of patients, who use water as irrigation solution
Clinical signs: chills, clammy skin, tight chest, bronchospasm
Oxygen carrying capacity decrease
Free hemoglobin increase
Hyperkalemia

13. Bladder Perforation
Caused by instrumentation, overdistension or explosion of hydrogen
Most bladder perforation is retroperitoneal
Clinical signs: return of irrigation solution decrease, abdominal distension

14. Prevention of TURP syndrome
Surgical technique
術前矯正electrolyte and fluid imbalance
Special attention to cardiac p’t
Height of irrigation solution bag
Duration of surgery

15. Treatment of TURP syndrome
Terminate surgery
Administer Lasix
Hypertonic saline (3-5%) for hyponatremia
Intubation for pulmonary edema
Diazepam for seizure

16. References
Transurethral Resection of the Prostate Syndrome: A Review of the Pathophysiology and Management
Anesthesia and Analgesia Feb ’97 438
Anesthesia for Renal and Genito-Urologic surgery
Complications of Urologic Surgery

17. Estimation of Fluid Absorption
Serum Sodium Dilution
[(Pre-Op Na)/ (Post-op Na) –1] x ECF
Breath-alcohol level
Patient’s weight gain