The transurethral resection syndrome

Abstract

The transurethral resection syndrome ("TUR syndrome") is caused by absorption of electrolyte-free irrigating fluid, and consists of symptoms from the circulatory and nervous systems. The clinical picture is inconsistent and the syndrome is easily confused with other acute disorders. Mild forms are common and often go undiagnosed, while severe forms of the TUR syndrome are rare and potentially life-threatening. The pathophysiology is complex but includes four mechanisms: circulatory distress from the rapid absorption of electrolyte-free irrigating fluid, adverse effects of glycine, dilution of the protein and electrolyte concentrations of the body fluids, and disturbance of renal function. The treatment of the TUR syndrome consists of general life support and in specific treatment directed towards hypotension, hyponatraemia and anuria. Methods to lower the uptake of irrigating fluid are widely used and probably reduce the incidence of the TUR syndrome. However, patient safety can be guaranteed only if the absorption is monitored. An irrigating fluid containing tracer amounts of ethanol can be used for this purpose. This permits the uptake of fluid to be indicated by measuring the concentration of ethanol in the patient's exhaled breath.

Hysteroscopy and anaesthesia

“…It has been shown that in prostatic resection that as much as 10-20 ml min -~ fluid are absorbed. 24 We think that similar amounts may be absorbed during hysteroscopy. There are no controlled .studies to show that the risks are increased if the resection time exceeds one and half hours.…”

“…3o Reports of central nervous system toxicity including encephalopathy and transient blindness from glycine have been reported in the urological and orthopaedic literature after prostatectomy and arthroscopy. 24 In a case study to determine factors associated with the development of encephalopathy, 65 adults (45 women and 25 men) with postoperative hyponatraemic encephalopathy were compared with a group of 674 adults (367 women and 307 men) with postoperative hyponatraemia but without encephalopathy. 47.48 Of the 34 patients who developed permanent brain damage or died, 33 were women.…”

Şiddetli bir TUR-P Sendromu olgusu

“…Takiplerinde 24 saat sonra Na değeri 140 mmol/L olan olgu 48 saat sonra üroloji kliniğine devredildi. [3,4]. TUR-P sendromunun patofizyolojisinde rol oynayan dört temel mekanizma; kullanılan irrigasyon sıvısının hızlı ve aşırı absorbsiyonu nedeniyle oluşan dolaşım yüklenmesine bağlı bozukluklar, glisine bağlı yan etkiler, vücut sıvılarındaki protein ve elektrolit konsantrasyonunun dilüsyonu ve renal fonksiyon bozukluklarıdır [4].…”

Anesthesia for Urological Surgery

“…The amount and rate of luid absorption depend on several factors such as hydrostatic pressure of the irrigation luids, bladder distention, the size of opened venous sinuses and the length of resection time [44]. If there is a suspicion of TURP syndrome, operation must be terminated immediately and blood samples including electrolytes, creatinine, glucose and arterial blood gases must be sent for analyses and electrocardiogram should be obtained [45]. Treatment of hyponatremia and excessive luid loading should be adjusted according to the severity of the patient's symptoms.…”