Spinal Anesthesia Facilitates the Early Recognition of TUR Syndrome

Abstract

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.

Nursing assessment of TURP syndrome: a pilot study

“…It may be caused by the irrigation fluids utilized during the procedure. The uptake of 1 L within 1 h leads to the condensation of serum sodium of between 5 and 8 mEq/L (Olsson et al, 1995;McGowan-Smith et al, 2016). This finding is also supported by Hawary et al (2009) in that hyponatremia is a sign and symptom of TURP syndrome.…”

“…Similarly, hypertension and tachycardia are rationalized by the rapid volume expansion into the bloodstream of greater than 200 mL/min (Desmond, 1970;Moorthy and Philip, 2001). Sodium levels lower than 115 mEq/L also accelerate tachycardia (McGowan-Smith et al, 2016). Some participants the study clearly described tachypnea as a sign and symptom of TURP syndrome.…”

“…In the previous discussion, particularly in phase two, a participant revealed that hypertension may occur in TURP syndrome. Sodium levels lower than 115 mEq/L also accelerate tachycardia (McGowan-Smith et al, 2016). Similarly, hypertension and tachycardia are rationalized by the rapid volume expansion into the bloodstream of greater than 200 mL/min (Desmond, 1970;Moorthy and Philip, 2001).…”

“…The uptake of 1 L within 1 h leads to the condensation of serum sodium of between 5 and 8 mEq/L (Olsson et al, 1995;McGowan-Smith et al, 2016). Two participating urological nurses expressed that hyponatremia traditionally occurs when TURP surgery is performed.…”

Systemic Tumor Seeding Secondary to Peritonitis due to the Immediate Postoperative Intravesical Instillation of Pirarubicin After Intravesical Explosion Induced Bladder Perforation During Bipolar Transurethral Resection of Bladder Tumors

“…Transurethral surgery is often performed under spinal anesthesia to help confer good postoperative analgesia and to reduce the stress response to surgery. The early detection of hyponatremia associated with TUR syndrome is facilitated in a conscious patient [8]. If transurethral surgery is continued without the surgeon's being aware of a bladder perforation in a patient during general anesthesia, then hyponatremia due to TUR syndrome may be aggravated because the patient is unconscious.…”