Transurethral resection syndrome in elderly patients: a retrospective observational study

Abstract

BackgroundTransurethral resection of the prostate (TURP) involves the risk of transurethral resection (TUR) syndrome owing to hyponatremia. Irrigation fluid type, duration of operation, and weight of resected mass have been evaluated as risk factors for TUR syndrome. The purpose of the present study was to identify risk factors related to TUR syndrome in the elderly.MethodsAfter obtaining approval from the Institutional Review Board, data on all elderly males (aged 70 years and older) who underwent TURP under regional anesthesia over a 6-year period at our institution were retrospectively reviewed.TUR syndrome was defined as evidence of a central nervous system disturbance such as nausea, vomiting, restlessness, confusion, or even coma with a circulatory abnormality both intra- and post-operatively. Patients were divided into two groups, positive and negative, for the occurrence of the syndrome. Data such as previous medical history, preoperative and postoperative serum data, weight of resected mass, duration of operation, irrigation fluid drainage technique, anesthetic technique, operative infusion and transfusion volume, and neurological symptoms were collected. Only observational variables with p < 0.05 on univariate analyses were included in the multivariate logistic regression model to ascertain their independent effects on TUR syndrome.ResultsOf the 98 patients studied, 23 had TUR syndrome (23.5%, 95% confidence interval [CI] 14.9–32.0%). Multivariate regression analysis revealed that volume of plasma substitute ≥ 500 ml (odds ratio [OR] 14.7, 95% CI 2.9–74.5), continuous irrigation through a suprapubic cystostomy (OR 4.7, 95% CI 1.3–16.7), and weight of resected mass > 45 g (OR 4.1, 95% CI 1.2–14.7) were associated with significantly increased risks for TUR syndrome (Hosmer-Lemeshow test, p = 0.94, accuracy 84.7%).ConclusionsThese results suggest that the use of a plasma substitute and continuous irrigation through a suprapubic cystostomy must be avoided during TURP procedures in the elderly.

Prediction of clinical manifestations of transurethral resection syndrome by preoperative ultrasonographic estimation of prostate weight

“…Our previous study also found this to be an important risk factor for TUR syndrome in older patients [12]. Such continuous drainage of irrigation fluid facilitates the removal of debris, blood, and clots from the operating field.…”

Management of Large Prostate Gland in Men with Impaired Renal Function: Comparison of Safety, Efficacy and Outcomes of Monopolar, Bipolar Transurethral Resection and Open Prostatectomy

“…The incidence of TURS in patients undergoing TURP is about 0.5-10.5%. The risk is exacerbated among the elderly (up to 24%) due to decreased reserve capacity and added co-morbidities [19,] and RF adds to the difficulty of the kidneys to handle excess fluid. However, modifications in TURP such as the use of bipolar energy have resulted in significant advantages over TURP including better and greater tissue removal, less bleeding, greater visibility, better hemostasis, shorter operative time, negligible chances of TUR syndrome shorter duration of postoperative irrigation and catheterization, and shorter hospital stay.…”

Health‐related quality of life in patients undergoing TURP: Translating evidence into urological nursing practice

“…Overall, both types of assessments must be applied to ensure a full evaluation of a patient's HRQoL. 12 113 As for achieving patient satisfaction relating to HRQoL, a detailed description of the current patients' condition and prior treatment must be clearly conveyed as it deserves. 107 Moreover, the laboratory findings could be predictors of the development of neurological and cardiovascular manifestations of TURP syndrome.…”

“…10 The prevalence of TURP syndrome rates were 2.0% to 4.8%, respectively. 12 Another study documented the cases of TURP syndrome were 11.1% in a clinical setting. 12 Another study documented the cases of TURP syndrome were 11.1% in a clinical setting.…”

“…11 A study from Japan reported that 23.5% of elderly patients experienced TURP syndrome. 12 Another study documented the cases of TURP syndrome were 11.1% in a clinical setting. 13 Over an enduring time-frame, this syndrome potentially leads to a devastating impact-particularly on patient's health-related quality of life (HRQoL).…”