Hyponatraemia Following Transurethral Resection of the Prostate

Abstract

In a prospective study of 100 patients undergoing transurethral resection, changes in serum sodium were estimated during the per-operative and post-operative periods. The weight of prostate resected and the volume of irrigant fluid used influenced the changes in serum sodium. In 93 patients these changes were not statistically significant. In only seven patients were significant falls in serum sodium recorded, in one case to a level of 103 mmol/l. All seven exhibited the clinical features of the transurethral syndrome and there was one post-operative death which we attributed to it. The TUR syndrome undoubtedly exists and its incidence in this series was 7%. Its pathogenesis and clinical management are discussed.

Volumetric Overload Shocks in the Patho-Etiology of the Transurethral Resection of the Prostate (TURP) Syndrome and Acute Dilution Hyponatraemia: The Clinical Evidence Based on Prospective Clinical Study of 100 Consecutive TURP Patients

“…The measured mean volume of glycine absorption, blood loss and changes of serum electrolytes are similar to those reported by other authors [29][30][31][32][33]. The Data indicate that a volume of >2 litres, gained in one hour, can lead to the TURP syndrome; >3.5 litres precipitates VOS1 and multiple system dysfunctions ( Figure 2).…”

Volumetric overload shocks in the patho-aetiology of the Transurethral Resection of the Prostate (Turp) Syndrome and acute dilution hyponatraemia: The clinical evidence based on prospective clinical study of 100 consecutive Turp patients

“…The measured mean volume of Glycine absorption, blood loss and changes of serum electrolytes are similar to those reported by other authors [29][30][31][32][33]. Data indicate that a volume of >2 litres, gained in one hour, can lead to the TURP syndrome; >3.5 litres precipitates VOS1 and multiple system dysfunctions ( Figure 2).…”

“…Hyponatraemia [4,5] hyponatraemic hypoalbuminasemic syndrome [35]), Hypocalcaemia [29] , , water intoxication and glucosepitressin (vasopressin) syndrome known in obstetrics are examples of syndromes induced by sodium-free fluid volumetric overload (VOS1) which have been attributed to the apparent changes in serum solute concentrations. Also, the rise in serum concentration of solutes gained from the absorbed fluid such as Glucose, Glycine and Sorbitol [19] or metabolites presumed to originate from them such as Ammonia [27] and Oxalates [45] have been incriminated as possible pathogenesis for the TURP syndrome.…”

Les troubles de l’équilibre hydrosodé chez les patients hospitalisés

“…to \100-110 mmol l -1 have been described and can be associated with serious neurologic sequelae and death. 46 Similar problems have been described with use of large volume glycine irrigation during hysteroscopy. 47 This diagnosis is supported by the finding of a large serum osmolal gap C30-40 mOsm kg -1 , whereas a normal serum osmolal gap is B5-10 mOsm kg -1 .…”

“…]. 46 Postoperative decreases in serum [Na ? ] to \100-110 mmol l -1 have been described and can be associated with serious neurologic sequelae and death.…”