Elsevier

Urology

Volume 64, Issue 2, August 2004, Pages 298-301
Urology

Adult urology
Dilutional hyponatremia of TURP syndrome: A historical event in the 21st century

https://doi.org/10.1016/j.urology.2004.03.023Get rights and content

Abstract

Objectives

To evaluate the risk of hyponatremia and transurethral resection of the prostate (TURP) syndrome after bipolar saline TURP in patients with large-volume, benign prostatic hyperplasia and statistically significant comorbidities.

Methods

Five patients with large symptomatic benign prostatic hyperplasia and significant comorbidities underwent saline TURP. Data were collected regarding patient profile, prostate weight, operative time, and perioperative events. In particular, we studied and compared the preoperative and postoperative serum sodium concentrations and hematocrit.

Results

The mean age was 68 years (range 57 to 76). The mean resection weight of the prostatic chips was 49.6 g (range 37 to 62). Senior urology residents under the supervision of the university faculty performed all procedures. The average operative time was 2 hours, 22 minutes (range 98 to 175 minutes). The mean serum sodium concentration decreased by 1.6 mg/dL (from 138.4 mg/dL preoperatively to 136.8 mg/dL postoperatively). The mean hematocrit decreased by 5.60% (from 40.24% preoperatively to 34.64% postoperatively). Postoperative recovery was uneventful in all 5 patients.

Conclusions

Bipolar saline TURP is safe and eliminates the risk of TURP syndrome in high-risk patients with large prostates that require lengthy resection. In addition, the system permits the faculty to spend the time needed for teaching and training urology residents without compromising patient safety.

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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