Role of preoperative assessment of serum sodium in transurethral resection of prostate to avoid transurethral resection of prostate syndrome: a comparative study

Background: Transurethral resection of prostate syndrome (TURP) syndrome is an iatrogenic complication caused by absorption of the irrigating fluid which is used to distend the bladder during surgery.Methods: A total of 100 patients with benign prostatic hyperplasia (BPH) were taken for study. Study was done in tertiary care centre in Gujarat from January 2016 to December 2017. They were evaluated pre-operative and post-operative for sodium concentration.Results: In this study most of the patients i.e. 32 were seen in age group 61- 65 years.31% cases have developed hyponatremia out of 6% were having serum sodium level <125 mEq/l. 56% of cases were having prostate gland <40 cc. In 70% cases, TURP was completed within 60 minutes, while 30% cases required more than 60 minutes time. 13 were seen in age group 51 to 60 years, means 40.62% patients of this age group (13/32) and 12 patients were seen in age group 71-80 years, means 52.17% patients of this age group (12/23) were having post-operative hyponatremia. Out of 31 patients, 20 patients (64.52%) were having prostate size more than 60 cc and 11 patients (35.48%) were having prostate size between 46 to 60 cc.Conclusions: From present study, it is concluded that electrolyte derangement occurs in older patients, with larger amount of tissue and longer time of resection and higher volume of irrigation fluid. It was also noticed that chances of electrolyte derangement are higher in patients with co-morbid conditions.

NURSING PATHWAY PROPHYLAXIS OF TURP SYNDROME OCCURRED IN HYSTEROS-COPY SURGERY / 现代医院

Objective To analysis the TURP syndrome occurred in hysteroscopy surgery clinical nursing pathway. Methods According to different to our hospital nursing path of 56 women underwent hysteroscopic surgery patients were di-vided into observation group and control group.In patients with excessive hydration syndrome (TURP) chance to compare. Results two groups of patients, compared the clinical effect of observation group was better than control group , significantly fewer number of patients, TURP syndrome (p<0.05).Observation group of palace pressure, fluid volume expansion palace, palace velocity is lower than the control group, the difference is statistically significant, p<0.01).Conclusion establishing a clinical nursing path to prevent hysteroscopy surgery complicated with excessive hydration syndrome , at the same time can effectively guide the clinical nursing work, improve the hysteroscopy surgery patients, and reduce the incidence of the exces-sive hydration syndrome.

Application of Dilute Pituitrin to Hysteroscopic Surgery / 中国微创外科杂志

Objective To assess the effect of dilute pituitrin solution (0.05 U/ml) on blood loss and distention fluid intravasation during hysteroscopy. Methods From January 2003 to June 2004, 68 women with abnormal uterine hemorrhage undergoing hysteroscopic endometrial resection were randomly divided into treatment and control groups (34 cases in each). In the treatment group, dilute pituitrin solution (0.05 U/ml) was injected into the cervix before dilation of the cervix in preparation for hysteroscopy, while the patients in the control received no pituitrin injection. Results The mean operation time in the treatment group was significantly shorter than that in the control [(32.2?6.0) min vs (35.9?6.8) min; t=-2.379, P=0.020]. The amount of distention fluid infusion in the treatment group was significantly less than that of the control [(2982.1?880.5) ml vs (3461.2?795.8) ml; t=-2.354, P=0.022]. The volume of distention fluid intravasation in the treatment group was significantly less than that of the control [(225.3?81.1) ml vs (319.4?89.2) ml; t=-4.551, P=0.000]. The rate of fluid intravasation was (7.5?1.1)% in the treatment group that was significantly lower than that in the control [(9.2?1.1)%, t=-6.372, P=0.000]. The mean blood loss in the treatment group was significantly less than that of the control [(15.1?4.1) ml vs (24.7?6.6) ml; t=-7.204, P=0.000]. Conclusions Intraoperative administration of dilute pituitrin solution can reduce blood loss, operation time, and the amount of distention fluid infusion and intravasation. As a result, it is useful to avoid post-hysteroscopy complications including TURP syndrome.

Transurethral Prostatectomy Syndrome / 대한마취과학회지

Water intoxication from intravascular absorption of non-electrolyte irrigating fluid is a well-known and often serious complication of TURP(transurethral resection of the prostate). The amount of fluid absorbed is related to the time elapsed, number of venous sinuses opening during resection and the height of the irrigation container. A 78-year-old male patient was performed TURP under spinal anesthesia. During the operation, chest discomfort, peripheral cyanosis, sinus bradycardia, drowsy mental state, hypoxemia, metabolic acidosis, severe hyponatremia, and pulmonary edema appeared. We had made a decision to stop operation immediately and transported to ICU. Endotracheal intubation and controlled mechanical ventilation with positive end expiratory pressure were performed and NaCI 240mEq, NaHCO3 240mEq, furosemide 20mg and 20% mannitol 200ml were injected for four hours. Three hours and forties minutes. after operation, reoperation was done for bleeding control. In consequence of reoperation, the patient began to improve in condition and came to settle in vital signs. We could extubate at dawn on the following day without any problem. We report this case and its management with the review of the relevant literatures.

Transurethral prostatectomy syndrome / 대한마취과학회지

A 70-year-old male was performed TURP (Transurethral resection of the prostate) under the diagnosis of benign prostate hyperplasia. Under general anesthesia, two times of TURP and suprapubic prostatectomy were performed for bleeding control during 8 hours. At the end of the operation, hypotension with bradycardia, severe ST elevation, QRS widening, T wave inversion and ventricular tachycardia on EKG appeared. Under the assumption of the diagnosis of hyponatremia, we treated with NaHCO3 and lasix, but cardiac arrest was followed by cardiopulmonary resuscitation. During postoperative five days, patient's cardiopulmonary status was supported by cardiotonic drugs and mechanical ventilation. We report this case to recall TURP syndrome and its management with the review of the relevant literatures.

The post-TURP change of the serum electrolyte and osmolarity by preoperative administration of furosemide / 대한비뇨기과학회지

To see the effectiveness of preoperatively administered furosemide for preventing Hypo-osmolarity and hyponatremia during TURP, 30 patients undergoing TURP were followed every preoperatively, 30 min intra-operatively as well as immediate postoperatively, 6 hours and 24 hours postoperatively with measurements of serum sodium, serum potassium and serum osmolarity. Among the 30 patients, 15 patients (experimental group) were administered furosemide immediately before TURP, the other 15 patients (control group) were not administered. We compared the changes of serum sodium, serum potassium and osmolarity of experimental group with those of control group. The result showed that the serum sodium and serum osmolarity were decreased significantly (p<0.01) in control group, but were not decreased significantly in experimental group. Thus, the preoperatively administered furosemide may prevent the dilutional hyponatremia and hypo-osmolarity during TURP, and may be helpful in high risk patient such as congestive heart failure and poor renal function.

The Relation between the Hyponatremia and the Amount of Irrigation Fluid during Transurethral Resection of Prostate / 대한마취과학회지

We know that irrigating fluid used during transurethral resection of prostate (TURP) is rapidly absorbed through open prostatic venous channels in large amount. The TURP syndrome is symptom complex of hypervolemia & hyponatremia (below 130 mEq/1) due to absorption of irrigating fluid. We studied the change of serum sodium, potassium and symptom of hypervolemia during the perioperative period, in 35 patients undergoning TURP. The aim of this clinical study was to examine the possible relation between the irrigating fluid absorption & the development of hyponatremia after TURP. The results were as follow. 1) Though p value was not acceptable, there waa numerical correlation between the weight of resected prostate and the amount of irrigating fluid. 2) TURP syndrome and severe sodium change were not reported in our studiea, 3) We through the cause of above results that operation time & minimal use of irrigating fluid & minimal bleeding due to advanced operative technique, adequate fluid therapy, and intenaive monitoring of vital sign & physiologic change of patients.

A Study of Blood Loss and Change of Serum Electrolytes During Transurethral Prostatic Resection / 대한비뇨기과학회지

The main problems of transurethral prostatectomy were operative blood loss and absorption of irrigating fluid. Blood loss is a significant factor in the morbidity and mortality of prostatic surgery. Early recognition while surgery is being performed is important to prevent development of hypovolemia, especially in the aged group. The reduced serum sodium and osmolarity concentration, regarded as cause of TURP syndrome, was caused by dilution by several liters of irrigating fluid. To better understand the hemodynamic changes occurring in patients undergoing transurethral prostatectomy, from January 1989 to July 1989, a program for prospective study of blood loss measurement, serum electrolytes change and other related factors was undertaken in 21 patients undergoing TURP by use of manufactured URIONE solution(Sorbitol 2.7gm + Mannitol 0.54gm/ 100ml distilled water) solution as irrigating fluid. An accurate measurement of blood was obtained by Hemoglobincyanide method, a colorimetric determination of hemoglobin in the irrigating fluid. Statistical evaluation of all data obtained was made using the "t test" with significance at 6 percent or less. There was a significant postoperative decrease in serum sodium and osmolality concentration, respectively averaging 3.7 +/- 3.8mEq/1, 8.4 +/- 8.1mOsm/kg. They were not correlated with absorbed irrigant fluid volume, resection time, weight of tissue resected( P>0.05). Blood loss ranged from 18 to 1250ml and its mean was 178ml. A statistically significant positive interrelationship was found among operative blood loss, resection time, irrigating fluid volume. Also significant correlation could be gained between absorbed irrigant fluid volume and serum sodium change(P<0.05 ), and resection weight and irrigation fluid volume(P<0.05).