Transurethral Resection of the Prostate (TURP) Syndrome: A Review of Perioperative Management

Abstract

Transurethral resection of the prostate (TURP) syndrome is a systemic complication caused by excessive absorption of electrolyte-free irrigation fluids during transurethral resection of prostate or bladder tumors. TURP syndrome can begin as early as 15 minutes after resection begins and can last up to 24 hours after surgery. The factors affecting the development of TURP syndrome are divided into two categories: patient-related factors (age, comorbid diseases, and prostate size) and surgery-related factors (type of irrigation fluid, duration, height of the fluid bag, absorption rate of irrigation fluid, and surgeon's experience). Signs and symptoms are due to hypervolemia, hyponatremia, and toxicity of substances in the irrigation fluid. Diagnosis is difficult because many signs and symptoms are variable and nonspecific. The clinical spectrum can range from asymptomatic hyponatremia and headache to nausea, vomiting, convulsions, visual disturbances, pulmonary edema, coma, cardiovascular collapse, and death. Since it may occur in the early perioperative period and causes central nervous system symptoms and signs, spinal anesthesia may be helpful for early diagnosis. When the diagnosis is made, informing the surgical team and ending the surgery is critical. Control of seizures, ensuring airway safety with endotracheal intubation, and treating hypervolemia, hyponatremia, and other electrolyte irregularities should be implemented immediately.