Transurethral resection of the prostate syndrome

Transurethral Resection of the Prostate Syndrome (TURP Syndrome) is a rare but potentially life-threatening complication that can occur during or after a Transurethral Resection of the Prostate (TURP) procedure. TURP is a common surgical procedure used to treat Benign Prostatic Hyperplasia (BPH), a condition characterized by the enlargement of the prostate gland which can lead to difficulty in urination.

Overview

TURP syndrome is primarily caused by the absorption of excessive irrigation fluid used during the TURP procedure into the systemic circulation. This can lead to a range of clinical manifestations including Hyponatremia (low sodium levels in the blood), fluid overload, Hypertension (high blood pressure), Pulmonary Edema (fluid accumulation in the lungs), and in severe cases, Cerebral Edema (swelling of the brain), which can be fatal.

Symptoms

Symptoms of TURP syndrome may include:

• Nausea and vomiting
• Confusion or mental status changes
• Hypertension or hypotension
• Bradycardia (slow heart rate)
• Visual disturbances
• Muscle cramps or weakness
• Seizures

Pathophysiology

The pathophysiology of TURP syndrome involves the absorption of large volumes of irrigation fluid into the venous system through open prostatic veins during surgery. The commonly used irrigation fluid is hypotonic, which can lead to a dilutional hyponatremia and a shift of water into cells, causing cellular edema.

Diagnosis

Diagnosis of TURP syndrome is primarily clinical, based on the presentation of symptoms and the timing of their occurrence during or after a TURP procedure. Laboratory tests showing hyponatremia and other electrolyte imbalances can support the diagnosis.

Treatment

Treatment of TURP syndrome focuses on correcting the fluid and electrolyte imbalances. This may involve:

• Restriction of fluid intake
• Administration of hypertonic saline to correct hyponatremia
• Diuretics to manage fluid overload
• Supportive care for other symptoms as needed

In severe cases, intensive care may be required to manage the complications of the syndrome.

Prevention

Preventive measures for TURP syndrome include careful monitoring of fluid balance during the procedure, using minimally invasive surgical techniques to reduce the risk of fluid absorption, and limiting the duration of the procedure to reduce exposure to irrigation fluids.

Conclusion

TURP syndrome is a serious complication of the TURP procedure, but with appropriate preventive measures and prompt recognition and treatment of symptoms, the risks can be minimized. Awareness and understanding of TURP syndrome among healthcare providers are essential for ensuring patient safety during and after TURP procedures.