TURP

Question 1

Why are electrolyte solutions not used as irrigation

during TURP?

Answer 1

They interfere with electrocautery and electrical current is
dispersed from the resectoscope
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1428.

Question 2

What irrigation fluids are used during TURP?

Answer 2

Slightly hypotonic nonelectrolyte irrigation solutions are used.
These include: glycine 1.5%, or mixture of sorbitol 2.7% and
mannitol 0.54%, mannitol 3%, dextrose 2.5-4%, urea 1%, and
sorbitol 3.3%
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 675.

Question 3

What nerve injury is associated with a TURP?

Answer 3

Compression of the peroneal nerve by the leg support device
used in lithotomy position.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 886.

Question 4

Why is a regional technique advantageous over

general anesthesia for a TURP?

Answer 4

The awake patient can aide in the early diagnosis of bladder
perforation (these patients often complain of shoulder pain that
is caused by blood or fluid irritating the diaphragm), and also
the early diagnosis of TURP syndrome.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1427

Question 5

What is the obturator reflex, how is it triggered during
a transurethral resection of a bladder tumor
(TURBT), and how
can it be prevented?

Answer 5

The obturator reflex results in external rotation and adduction of
the thigh from stimulation of the obturator nerve. Electrocautery
current that contacts the lateral wall of the bladder (which may
occur during a transurethral resection of a bladder tumor) can
stimulate this reflex. This could result in bladder perforation due
to patient movement while instruments are in the bladder.
Regional anesthesia does not reliably block this reflex.
Administration of muscle relaxants is required to prevent its
occurrence.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 682.