Abstract
Introduction an importance
Transurethral resection of prostate (TURP) is a rare but extremely dangerous condition. Although this complication is well described previously, we still see it those days.
Case presentation
We report a case of 66-year-old male patient presented with symptoms of enlarged prostate. Ultrasound showed the prostate weight was 90 g. He was scheduled for transurethral resection of prostate. The procedure took 65 min with the use of monopolar device. One hour after operation, he had confusion, bradycardia, and elevated blood pressure. Laboratories showed hyponatremia and hyperkalemia. We infused the patient with saline 3% solution after the diagnosis of TURP syndrome. On next day, he gained his full recovery and we discharged him.
Clinical discussion
Our patient suffered from TURP syndrome. Laboratory evaluation of blood electrolytes led to confirm the diagnosis. We immediately infused hypertonic saline intravenously. We monitored the patient clinically and with serial assessments of blood electrolytes.
Conclusion
TURP syndrome is considered a serious complication in urology surgery. Urologists should suspect this complication in prolonged TURP surgery. Early diagnosis is crucial to save patient's life.
Keywords: Benign prostatic hyperplasia, Case report, TURP syndrome
Highlights
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Transurethral resection of the prostate (TURP) syndrome is rare but fatal medical condition.
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Time is crucial when performing transurethral resection of the prostate.
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Early diagnosis of TURP syndrome led to prevent death in some cases.
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Serial blood electrolytes assessments and the clinical state of the patient are the corner stone during fluid resuscitation.
1. Introduction
Transurethral resection of prostate (TURP) syndrome is a systemic complication of transurethral resection of the prostate or bladder tumors, caused by excessive absorption of electrolyte-free irrigation fluids [1].
This syndrome may potentially cause neurologic disturbance, pulmonary edema, cardiovascular compromise, and death. Normal saline cannot be used as irrigation solution with conventional monopolar resection. Glycine solution is almost universally used as an irrigation solution in traditional therapeutic endoscopic urologic procedures [2].
TURP Syndrome has become a rare event in recent years, with incidence rates between 0.78% and 1.4% [3].
We report a rare case of TURP syndrome in a 66 years old patient that happened after 1 h of surgery. Early recognition of the condition led to full recovery.
This case report was prepared in accordance with the SCARE guidelines [4].
2. Case presentation
A 66 years old male presented to our clinic with seven months of lower urinary tract symptoms. Ultrasound showed prostate weight 90 gr. The patient had no other diseases. After taking patient consent, we decided to perform transurethral resection of prostate (TURP). On operation day, the patient had the laboratory values: 11 × 105white blood cells, 12 × 105HGB, 320 × 105 PLT, 1.1 mg/dl creatinine, 20 mg/dl urea, 102 mg/dl Glucose, 134 mmol/l Na, and 5 mmol/l K. He was positioned on lithotomy posture. We started the operation under spinal anesthesia. During the operation, the blood pressure was 120/70 mm/Hg, pulse 72/bpm, Spo2 97%. He was given 1.5 l of normal saline via intravenous. We used 20 l of 1.5% glycine during operation. We needed 65 min to complete the surgery. The course of the surgery was unremarkable. One hour after surgery, the patient developed confusion, pin-point pupil, hypoxemia (spo2 83%), hypertension 170/95 mm/Hg, and bradycardia (58 bpm). Lung and heart auscultations were normal. The diagnosis was TURP syndrome. Immediately, the patient was infused by 500 ml of normal saline (0.9). In addition, he was given nebulization with salbutamol. A blood specimen was sent to the laboratory. Chest x-ray and ECG were normal. Laboratory findings showed hypernatremia (121 mm/l) and increased potassium level (6.3 mm/l). Finally, he was loaded with 300 ml of saline 3% over the next 6 h. After 12 h, we had normal electrolyte values (137 mmol/l, and 4 mmol/l of K). On next day, we discharged our patient with a good state.
3. Discussion
Transurethral resection of the prostate (TURP) is the most common surgical procedure performed on male patients over 60 years of age. Irrigation of closed body spaces may lead to perioperative fluid and electrolyte shifts [5].
Glycine 1.5% solution is commonly used for TURP because it is inexpensive, nonconductive, and only slightly hypoosmolar, reducing the risk of burn injury or significant hemolysis [1].
TURP Syndrome is a clinical condition characterized by neurologic and cardiovascular disturbances, that results from excessive absorption of electrolyte-free irrigation fluids, through the opened prostatic venous channels (intravascular) and the perforated prostatic capsule (extravascular) [6].
The diagnosis of TURP syndrome should be rapid, so, the spinal anesthesia is considered to be the anesthetic technique of choice, allowing early detection of neurological symptoms (patient awake). The treatment of severe TURP syndrome is based on correcting electrolytes and making patient hemodynamically stable [1].
Our patient had TURP syndrome after 1 h of TURP operation. He developed neurological and vascular symptoms. We immediately infused normal saline intravenously. Laboratory tests after surgery showed a significant raise in potassium levels and a decrease in sodium levels. Treatment was mainly directed to regain the normal values of blood electrolytes. We administrated intravenous hypertonic saline 3%. We monitored vital signs, neurological symptoms, and consciousness. After 6 h, we repeated the blood tests. Laboratory findings showed normal values of both sodium and potassium levels. On the next day, we discharged our patient after full recovery.
4. Conclusion
We presented a rare but dangerous case about TURP syndrome. The main point is to diagnose this condition earlier as soon as possible. Treatment is consisted of normalization of the electrolytes levels.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Provenance and peer review
Not commissioned, externally peer reviewed.
Ethical approval
No ethical approval was sought for this case report.
Consent
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
Guarantor
Dr. Maher Al-Hajjaj.
Registration of research studies
Not applicable.
Credit authorship contribution statement
Maher Al-Hajjaj: contributed in study concept and design, data collection, and writing the paper.
Muhamad Kanjo: contributed in data interpretation and writing the paper.
Mohamed Tallaa: contributed in data interpretation and writing the paper.
Declaration of competing interest
The authors declare having no conflicts of interest for this article.
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