[Value of transurethral resection of the prostate (TURP) for treatment of symptomatic benign prostatic obstruction (BPO): an analysis of efficiency and complications in 1015 cases]

Syndrome of inappropriate antidiuretic hormone secretion following bipolar transurethral resection of the prostate

Syndrome of inappropriate antidiuretic hormone secretion following minimally invasive surgery is extremely rare, having only been reported in a handful of cases. We present the second documented case of syndrome of inappropriate antidiuretic hormone secretion following transurethral resection in an 80-year-old male undergoing bipolar transurethral resection of the prostate for bladder outflow obstruction.

Level of evidence: 5

TUR syndrome - A report

We report a case of transurethral resection of prostate (TURP) syndrome. A 80-year-old man with grade III Prostatomegaly was scheduled for transurethral resection of the prostate under spinal anesthesia. Just after the end of the surgery, the patient presented signs of TURP syndrome with bradycardia, arterial hypertension, hypoxemia and dizziness-confusion. The electrolytes analysis revealed an acute hyponatremia (sodium concentration 120.6 mmol/L) and hyperkalemia (potassium concentration 6.48 mmol/L). Medical treatment consisted of hypertonic saline solution 3% and nebulization with levosalbutamol. The presented case describes a typical TURP syndrome, which was diagnosed and treated early. The patient was discharged from hospital without any complications.

[TURP syndrome: about a case]

Nous rapportons le cas d'un patient de 78 ans, sans antécédents pathologiques notables, qui a bénéficié d'une résection transuréterale d'une hypertrophie bénigne de prostate de 50g sous rachianesthésie. Ce patient a présenté, 90 minutes après le début de l'intervention, des nausées vomissements, brouillard visuel et bradycardie en rapport avec un TURP syndrome. L'ionogramme a objectivé une natrémie à 118meq/l, d'où sa mise sous sérum salé hypertonique à 3% avec bonne évolution. Cette observation décrit une forme typique mais modérée du TURP syndrome dont la prise en charge était facilitée par l'état d'éveil du patient permis grâce à la rachianesthésie.

Sudden occurence of hypotension and bradycardia during greenlight laser transurethral resection of prostate: case report of two cases

Background

Greenlight laser transurethral resection of prostate (TURP) is a standard surgical method used to treat patients with prostate gland enlargement, it is safe and effective.

Case presentation

We report two cases of sudden occurence of hypotension and bradycardia during greenlight laser TURP. Two patients with benign prostatic hypertrophy were scheduled for greenlight laser TURP under spinal anesthesia. Hypotension and bradycardia were suddenly occurred during the operation. The blood gas analysis revealed no hyponatremia (indicating TURP syndrome) or anemia (indicating hemorrhage). Operation was suspended and inotropic agents were administrated intravenous immediately, then blood pressure and heart rate increased to normal level within some minutes. The patients were discharged from hospital without any complications. We considered parasympathetic reflex was occurred during greenlight laser TURP.

Conclusion

Apart from TURP syndrome, hemorrhage, bladder perforation and high spinal anesthesia, the parasympathetic reflex which is caused by operative process can also induce hypotension and bradycardia during TURP.

Spinal Anesthesia Facilitates the Early Recognition of TUR Syndrome

OBJECTIVES

To investigate what clinical features typically present in transurethral resection (TUR) syndrome and to see which classically present first. The purpose of the study was to establish whether or not a particular method of anesthesia is preferred in detecting this syndrome in its early stages.

METHODS

A total of 1,502 transurethral resection of the prostate (TURP) over a 15 year period were reviewed to see which, if any, went on to experience this complication. Of these cases, 48 developed TUR syndrome. The case records were reviewed retrospectively and the presenting clinical features were analysed. All TURPs were routinely performed under spinal anesthesia and followed a standardised set up. The irrigation fluid used in all operations was Glycine 1.5%.

RESULTS

Forty eight patients displayed clinical features of TUR syndrome giving an incidence of 3.2%. Trainees of varying experience caused all but one case. Median resection time, resection weight and volume of intraoperative glycine irrigation fluid were 55 minutes (range 40-75 minutes), 44 grams (range 24-65 g), and 28 l (24-48 l) respectively. Only 16/48 TURPs had a recorded capsular perforation. Pre- vs. post-operative median hematocrit, hemoglobin and serum sodium were 0.42 vs. 0.33, 14.2 g/dl vs. 10.1 g/dl and 142 mmol/l vs. 121 mmol/l respectively. Patients presented with nausea 44/48, vomiting 28/48, visual disturbance 29/48, apprehension 37/48, disorientation 17/48, breathing difficulties 17/48, and bradycardia 19/21. The earliest observed sign was nausea 21/48, then bradycardia 11/48, apprehension 11/48, and visual disturbance 10/48; after which the procedure was abandoned. None of the patients developed stupor, coma or seizures. Out of the 48 patients, 9 were admitted to high dependency units and all of these were treated with IV furosemide. One patient required a blood transfusion. All patients recovered within 48 hours (range 18-48 hours) and none had any long term complications on follow up.

CONCLUSION

The features most associated with the early presentation of TUR syndrome require the patient to be conscious for detection. The use of spinal anaesthesia is therefore desirable to facilitate its early recognition.

Atypical presentation of acute hyponatremia in transurethral resection of prostate surgery: A case report

We report a case of unusual presentation of transurethral resection of prostate (TURP) syndrome. A 58-year-old male patient with grade III benign hypertrophic hyperplasia was scheduled for TURP under spinal anesthesia. At 120 min of surgery, the patient presented with atypical symptoms of tightness in the chest with difficulty in breathing. The electrolyte analysis revealed an acute hyponatremia (serum Na⁺ 95 mEq/l). Patient was successfully treated with rapid infusion of 3% hypertonic saline along with furosemide.

Transurethral resection of prostate syndrome: report of a case

We report a case of transurethral resection of prostate (TURP) syndrome. A 78-year-old man with prostatic hypertrophy was scheduled for transurethral resection of the prostate under spinal anesthesia. 30 minutes after the end of the surgery, the patient presented signs of TURP syndrome with bradycardia, arterial hypotension, cyanosis, hypoxemia and coma. The electrolytes analysis revealed an acute hyponatremia (sodium concentration 125 mmol/L). Medical treatment consisted of hypertonic saline solution 3%, volume expansion, intubation and ventilation. The presented case describes a typical TURP syndrome, which was diagnosed and treated early. The patient was discharged from hospital without any complications.