Transurethral prostate resection syndrome: skeleton in the closet is still lurking!
Tatjana Šimurina, Boris Mraović, Miroslav Župčić, Sandra Graf Župčić, Igor Grubješić, Livija Šakić, Tomislav Sorić
Objectives: Transurethral resection of the prostate (TURP) is often performed as a day case surgery. Although it is considered a safe procedure, serious perioperative complications could occur. TURP syndrome is a rare but potentially life-threatening complication.The objective of this clinical update, based on recently published literature, was to discuss the incidence, pathophysiology and clinical picture of TURP syndrome. Methods: A comprehensive review of medical literature search utilizing PubMed, Ovid Medline® and Google Scholar from January 1st 2017 to January 1st 2020 was performed. Results: Pathophysiology of TURP syndrome is multifactorial. Clinical symptoms vary from mild to severe and they depend on the rate and amount of intravascular absorption of the irrigation solution into the circulation, type of the irrigation solution, and patients and surgical factors. Acute volume load into the circulation could lead to pulmonary edema and cardiac arrest, whilst solute changes in plasma like hyponatremia ,as well as hypotonicity and hypoosmolality of plasma may cause central nervous system (CNS) disturbances. Early detection of clinical symptoms in anesthetized patients is difficult but crucial for early treatment. The treatment must be in accordance with the severity of clinical symptoms and signs. Spinal anesthesia has advantages over general anesthesia because it allows monitoring and early detection of CNS symptoms in conscious patients. Conclusions: This narrative review provides an update on TURP syndrome with an emphasis on prevention, early diagnosis and treatment of this iatrogenic complication.Improved understanding of etiology, preventive measures, newer surgical techniques, and intensive monitoring facilitate further risk reduction of TURP syndrome.
Boris Mraović, Igor Grubješić, Livija Šakić, Miroslav Župčić, Sandra Graf Župčić, Tatjana Šimurina, Tomislav Sorić