TURP Flashcards
TURP (transurethral resection of the prostate) syndrome is an iatrogenic complication caused by absorption of the irrigating fluid which is used to distend the bladder during surgery. Between 1% and 8% of TURP procedures are complicated by TURP syndrome
The syndrome has also been reported after endometrial ablation and
ureteroscopic procedures. TURP syndrome can occur within 15 minutes after resection starts or up to 24
hours postoperatively
The nerve supply is from the prostatic plexus (originates from the inferior hypogastric plexus), which
carries both sympathetic (T11 to L2) and parasympathetic (S2 to S4) fibres.
Bladder distension pain is carried by sympathetic fibres T11 to L2
The properties of an ideal irrigation fluid are: • Transparent (allows visualisation) • Isotonic • Electrically non- conductive (to allow diathery to work) • Non-haemolytic • Not metabolised • Non- toxic • Inexpensive • Sterile.
The most commonly used fluids for irrigation are:
1.5% glycine
Mannitol 5%
Sorbitol 3.5%
Complicações pos operatorias:
Bladder spasm, Bleeding - blood loss is usually ∼ 500ml,
Clot retention - this can occur if bladder irrigation is inadequate. This can cause bladder overdistension,
and hence vagal stimulation as well as pain
TURP syndrome
Turp sindrome - Symptoms and signs caused by an excess absorption of irrigation fluid
into the circulation. It occurs due to acute changes in:
• Intravascular volume
• Plasma Na+ concentration
• Osmolality
fatores que predispõe:
Hydrostatic pressure of irrigation fluid-
Low peripheral venous pressure (e.g. if patient is hypovolaemic, or hypotensive)
Duration of surgery- should be no more than 1 hour.
Large blood loss i.e. open prostatic vessels through which irrigation fluid is absorbed
Capsular or bladder perforation
Rapid absorption of large volumes of irrigation fluid can cause hypertension with reflex bradycardia, and
can precipitate acute cardiac failure and pulmonary oedema. Rapid equilibration of hypotonic fluid with
the ECF can cause sudden hypotension and hypovolaemia.
Rapid absorption of large volumes of irrigation fluid can cause hypertension with reflex bradycardia, and
can precipitate acute cardiac failure and pulmonary oedema. Rapid equilibration of hypotonic fluid with
the ECF can cause sudden hypotension and hypovolaemia.
Glycine is an inhibitory neurotransmitter in the CNS and retina. Using 1.5% glycine irrigation early
features of TURP syndrome include restlessness, headache, tachypnoea, a burning sensation in the face or hands or visual disturbance.
NMDA receptor activity is potentiated by glycine, which can cause encephalopathy and seizures.
Magnesium has a negative effect on NMDA receptors, and membrane stabilising effect. Hence, Mg2+
should be considered for seizure control in TURP syndrome
TRATAMENTO:
Surgery must be stopped.
IV fluids should be stopped.
Airway and breathing - support respiration, if necessary (intubation & ventilation
Circulation- bradycardia and hypotension should be treated with glycopyrrolate and vasopressors.
Seizures should be treated with anticonvulsants (eg diazepam, lorazepam, thiopentone), i.v.
magnesium.
Diuretics (e.g. frusemide 40mg) is only recommended if there is acute pulmonary oedema (due to
transient hypervolaemia). Frusemide may further decrease Na+, but it is effective at removing free
water. Mannitol (eg 100ml of 20%) causes less Na+ loss than loop diuretics.
Severe hyponatraemia (ie Na+ < 120mMol/L, or severe symptoms such as transient blindness,
persistent nausea and vomiting, severe headaches, hypotension (drop in systolic of >50mmHg)) should
be treated by increasing extracellular fluid tonicity in order to shift water from ICF to ECF, thus
ameliorating cerebral oedema. This can be achieved using:
Hypertonic saline (3%) in those with normal renal function,
Haemofiltration - if the patient has chronic renal failure
8.4% NaHCO3 can be used if hypertonic saline is unavailable
