Change in serum sodium level predicts clinical manifestations of transurethral resection syndrome: a retrospective review

Abstract

BackgroundPatients undergoing transurethral resection (TUR) of the prostate are at risk of TUR syndrome, generally defined as having cardiovascular and/or neurological manifestations, along with serum sodium concentrations less than or equal to 125 mmol/l. As these symptoms can also occur in patients with serum sodium greater than 125 mmol/l, this study aimed to investigate the relationship between serum sodium concentrations and neurological manifestations of TUR syndrome.MethodsData on patients who underwent TUR of the prostate under local anesthesia over an 8-year period were retrospectively reviewed. Based on their cardiovascular and neurological manifestations, patients were divided into two groups: a symptomatic and an asymptomatic group. Logistic regression analysis was used to detect the risk factors for being symptomatic. Receiver operator characteristic (ROC) curve analysis was used to determine the optimal cutoff value of estimated change in serum sodium level that could predict the development of clinical manifestation of TUR syndrome.ResultsOf the 229 patients, 60 showed symptoms. Serum sodium level correlated with neurological score (Spearman’s correlation coefficient > 0.5). Logistic regression detected that the risk factors for being symptomatic were serum sodium level variables, operation time longer than or equal 90 min, and presence of continuous drainage from the bladder. ROC curve analysis showed that a change in serum sodium level of 7.4 mmol/l was the optimal cutoff value, with a sensitivity of 0.72, a specificity of 0.87, and an area under the curve (AUC) of 0.87. ROC curve analysis also showed that a 7.0% change in serum sodium level was optimal for this parameter, with a sensitivity of 0.70, a specificity of 0.89, and an AUC of 0.87.ConclusionsChanges in serum sodium concentration of > 7 mmol/l and of > 7% could predict the development of cardiovascular and neurological manifestations, which were assumed to be symptoms of TUR syndrome.

Nursing assessment of TURP syndrome: a pilot study

“…Furthermore, visual disturbances were highlighted by a participant in the previous discussion, as a sign and symptom of TURP syndrome. Our findings are supported by Ishio et al (2015) whereby in their retrospective study, they explained that decreasing serum sodium levels of >7·4 mEq/L or >7·0% potentially developed manifestations of central nervous system disturbances amid TURP syndrome, including nausea and vomiting, disorientation and visual disturbances. This problem appears when glycine-saline is utilized as irrigation fluid (Rassweiler et al, 2006).…”

“…However, anaesthesia providers, urologists and urological nurses should recognize whether nausea and vomiting has been caused by anaesthesia agents, or TURP syndrome (Chamber, 2002). Our findings are supported by Ishio et al (2015) whereby in their retrospective study, they explained that decreasing serum sodium levels of >7·4 mEq/L or >7·0% potentially developed manifestations of central nervous system disturbances amid TURP syndrome, including nausea and vomiting, disorientation and visual disturbances. Such central nervous system disturbances should be monitored intensively by nurses post TURP surgery, in order to prevent serious complications in relation to this syndrome.…”

“…0 "zero" : negative b. Moreover, a previous study also reported hypertension as a manifestation of TURP syndrome (Ishio et al, 2015). Unfortunately, this mechanism was still unclear.…”

Health‐related quality of life in patients undergoing TURP: Translating evidence into urological nursing practice

“…106 Objective, as well as subjective symptom assessments, should be taken into consideration amid the full range of psychological states. 108 Measuring a baseline level of sodium is practical prior to undergo endourological surgery when there is a potential risk factor of excess fluid absorption. Overall, both types of assessments must be applied to ensure a full evaluation of a patient's HRQoL.…”

“…,108 To deal with this issue, choosing an appropriate irrigation solution is a helpful method in preventing TURP syndrome at an early stage. This should be nontoxic, not metabolized, nonhemolytic, isotonic, and able to be excreted rapidly, if absorbed 110.…”