Adult urologyDilutional hyponatremia of TURP syndrome: A historical event in the 21st century
Section snippets
Material and methods
The medical records of 58 patients who had undergone TURP during a 3-year period (2001 to 2003) at the Atlanta Veterans Affairs Medical Center were reviewed. Patients were subcategorized according to their resected prostate weight. For the analysis, we selected patients with a large prostate resection weight (greater than 35 g) and significant comorbidities as determined by an American Society of Anesthesiologist risk classification of 3 or greater.
All patients had a preoperative diagnosis of
Results
Of a total of 58 patients, 5 fulfilled the inclusion criteria and were included in the analysis. The mean patient age was 68 years (range 57 to 76). One patient had severe voiding symptoms (American Urological Association Symptom Index 32) and a maximal urinary flow rate of 10 mL/s. The remaining 4 patients had chronic urinary retention and were either catheter dependent or using clean intermittent self-catheterization. All 5 patients were considered to be American Society of Anesthesiologist
Comment
The inherent physical properties of conventional monopolar TURP systems necessitate the use of nonconductive fluid irrigation such as glycine, sorbitol, or mannitol. Historically, sterile water, glucose, and urea were also used.6 Glycine and sorbitol are currently the two most commonly used fluids. Although all are nonconductive fluids that allow for electrocautery resection, they are hypotonic. Various attempts to increase their osmolality to isotonic levels resulted in compromised endoscopic
Conclusions
The results of this study have demonstrated the safety profile of bipolar saline TURP in high-risk patients with large prostates who require lengthy resection. The system uses normal saline for irrigation, eliminating dilutional hyponatremia and TURP syndrome. In addition, the system allows the faculty to spend the time needed for teaching and training urology residents without compromising patients' safety.
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