Water Intoxication after 15 Minutes of Transurethral Resection of the Prostate

Hurlbert, Barbara J.; Wingard, Daniel W.

doi:10.1097/00000542-197904000-00014

Cited by 41 publications

(7 citation statements)

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“…13,14 Severe TURP syndrome is rare; however, its mortality rate, unlike that of milder forms, has been quoted as high as 25%. 15 TURP syndrome may be seen from as early as 15 minutes after resection starts 16 to up to 24 hours postoperatively. 17 This long period reflects the need for the different teams that are involved in the patients perioperative and postoperative care to be aware of the early signs and symptoms of TURP syndrome to ensure that the right diagnosis is reached without delay and for the appropriate management to be instituted.…”

Section: Introductionmentioning

confidence: 99%

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

Hawary

Mukhtar

Sinclair

et al. 2009

Journal of Endourology

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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.

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Section: Introductionmentioning

confidence: 99%

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

Hawary

Mukhtar

Sinclair

et al. 2009

Journal of Endourology

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“…Several proposed strategies are present for reduction in risk of fluid absorption during TURP, but none has been completely successful. Resection time is suggested to be kept below 60 min for minimal fluid absorption (27). In our study, three patients developed clinical TUR syndrome (0.3%), and the value of <135 mEq/L was used to define hyponatremia.…”

Section: Discussionmentioning

confidence: 91%

Is Routine Measurement of Post-operative Hemoglobin and Electrolytes Necessary in Every Patient After Transurethral Resection of the Prostate?

Mithani¹,

Ehsan²,

Khan³

et al. 2018

jus

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Öz Amaç: Transüretral prostat rezeksiyonu (TURP) sonrası, hastalarda postoperatif hemoglobin ve elektrolit izleminin önemini değerlendirmek ve izlem için dikkate alınması gereken parametreleri belirlemektir. Objective: To evaluate the importance of post-operative hemoglobin and electrolyte monitoring after transurethral resection of the prostate (TURP) and establish the parameters to be considered for monitoring. Materials and Methods: Data of patients who underwent TURP between 2007 and 2017 were reviewed. Data regarding prostate size, irrigation fluid volume, resection time, pre-and post-operative electrolytes, hemoglobin levels taken within 48 hours before and after surgery, and blood transfusion information were collected. In order to establish parameters for post-operative laboratory monitoring, we categorized prostate size, resection time, and irrigation fluid into groups i.e. (<45 g, 45-60 g, 61-80 g and >80 g), (<30 min, 31-60 and >60 min) and (<20 L, 21-40 L and >40 L) respectively. Results: A total of 1.000 patients were included. The median age was 66 years with the minimum of 46 years and maximum of 98 years. The median prostate size was 54.26 g. Among all pre-and post-operative laboratory parameters, only hemoglobin and sodium showed a significant change, which were analyzed further. Drop in hemoglobin was significantly associated with increasing prostate size and volume of irrigation fluid. Patients with a prostate size of >80 g had 27.3 times higher chance of significant (>2 g) drop in hemoglobin while 5.1 times higher when irrigation volume exceeded 40 liters. Low levels of sodium were strongly associated with prostate size, irrigation fluid volume, and resection time. However, all these factors become insignificant (p≥0.05) for their effect on low sodium, when these variables were adjusted with each other. Blood transfusion was performed in 27 patients. All these patients belonged to a group of patients with prostate size of more than 80 g with high resection time and irrigation fluid volume. Three patients had TUR syndrome. Post-operative hemoglobin and electrolytes monitoring contributed to a change in the management of only 14% of patients. Conclusion: Routine post-operative hemoglobin and electrolyte measurement is not required in every patient undergoing TURP. Use of risk stratification approach will help us to decide which patient needs post-operative lab testing.

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“…Different studies have been proposed in regard of this but none of them are capable to eliminate these complications. One of the proposed study suggested that the chances of fluid absorption can be minimize if the resection time is kept below 60 min, their study also noted that when time of resection exceed more than 15 minutes then the TURP syndrome is documented 20 . In order to do fluid balance in every patient, monitoring is necessary.…”

Section: Discussionmentioning

confidence: 99%

Transurethral Resection in benign Prostatic Hyperplasia; An Observational Study Highlighting the Correlation of the Resected Tissue with Electrolytes and Hemoglobin

2019

J Liaquat Uni Med Health Sci

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OBJECTIVE: To determine the correlation of serum sodium and potassium levels before and after transurethral resection of the prostate with weight of resected tissue in BPH patients. METHODOLOGY: A prospective observational study was conducted on 75 male patients aged 40-70 years, presenting with benign prostatic hyperplasia and undergoing transurethral resection of the prostate at Department of Urology, Liaquat University of Medical and Health Sciences, Jamshoro. Ethical permission was taken before conducting this study from the university. Blood samples were obtained before and 24 hours after surgery for assessment of sodium and potassium levels. SPSS version 20.0 was used for data analysis. Pearson Correlation was applied for inferential analysis whereas p-value of < 0.05 was taken as significant. RESULTS: No correlation exist between baseline sodium level before resection(r=0.116 p=0.304) and 24 hours after the resection of prostate (r=0.219, p=0.051) and between baseline potassium level before resection (r=0.059, p=0.604) and 24 hours after the resection of prostate (r=-0.058, p=0.611) whereas moderate negative correlation (r=-0.310, p=0.005) exist between changes in potassium level with respect to weight of resected tissue. No correlation exist between exist between pre-operative hemoglobin level with respect to weight of resected tissue. (r=0.182, p=0.106). Moderate negative correlation (r=-0.309, p=0.005) exist between post-operative hemoglobin level whereas strong positive correlation (r=0.690, p=0.001) exist in operative time with weight of tissue resected. CONCLUSION: The results of the study showed that moderate negative correlation exists between changes in potassium level and post-operative hemoglobin level and strong positive correlation exists in operative time with respect to weight of resected tissue.

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Water Intoxication after 15 Minutes of Transurethral Resection of the Prostate

Cited by 41 publications

References 0 publications

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

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

Is Routine Measurement of Post-operative Hemoglobin and Electrolytes Necessary in Every Patient After Transurethral Resection of the Prostate?

Transurethral Resection in benign Prostatic Hyperplasia; An Observational Study Highlighting the Correlation of the Resected Tissue with Electrolytes and Hemoglobin

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