Transurethral Resection of the Prostate Syndrome: Almost Gone but Not Forgotten

Abstract

Transurethral resection of the prostate (TURP) syndrome is a rare but potentially fatal syndrome with multifactorial pathophysiology that is now better understood. Unfortunately, despite this improved understanding, it is not yet obsolete and still remains a risk. Many reviews of TURP syndrome have been presented from an anesthetic perspective; this review reflects more the urologic perspective with emphasis on the importance of multidisciplinary management of this complex syndrome. We present a review of TURP syndrome that specifically assesses advances in the understanding of risk factors, pathophysiology, and techniques used to prevent this syndrome. The databases Medline, Embase, Cochrane Controlled Trial Register, and Database of Abstracts of Reviews of Effects were systematically reviewed from inception to April 2009 for the keywords TUR (P), TUR (P) syndrome, and transurethral resection of prostate. There was no language restriction for our search. Randomized controlled trials, review articles and case series were included in our search. Our review showed a declining trend in the incidence of TURP syndrome despite TURP remaining the gold standard for the management of benign prostatic obstruction. Technologic advances using an array of laser techniques, the use of bipolar circuitry, together with advances in training techniques have helped minimize the risk of development of this syndrome. This review demonstrates the complexity of TURP syndrome. Even with a greater understanding of the pathophysiology, it highlights the unpredictability of the syndrome from presenting symptoms, preventative measures, and management. TURP syndrome cannot be protocol driven and the need for vigilance, a high index of suspicion, intensive monitoring, and a multidisciplinary approach is vital.

Long-term Follow-up of Transurethral Enucleation Resection of the Prostate for Symptomatic Benign Prostatic Hyperplasia

“…Although TURP shows long-term safety and high efficacy, about 20% of patients experience complications, including intraoperative hemorrhage, clot retention, and transurethral resection (TUR) syndrome [1][2][3][4].…”

Acute encephalopathy in a kidney transplant recipient following infusion of intravenous immunoglobulin

“…In the literature, hyperammonemia secondary to glycine metabolism has been recognized in the context of the transurethral resection of prostate (TURP) syndrome. TURP syndrome is a rare lifethreatening complication after surgery due to the absorption of glycine-containing irrigation fluid that leads to cardiovascular, neurological, and notable metabolic changes similar to our patient case -hyponatremia, hyperammonemia, and hyperglycinemia [5][6][7]. TURP syndrome has also been reported in other procedures using glycine irrigation fluid [8].…”

Anesthesia for Urological Surgery

“…Finally, visual disturbances, confusion, seizures and eventually coma may be observed. These CNS disturbances have been atributed to hyponatremia, which occurs with the absorption of any type of irrigating solution and hyperglycinemia and/or hyperammonemia if glycine is used [42,43]. 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].…”