TURP: benefit of spinal

Advanced, Clinical - Renal/Urine/Electrolytes, Organ-Based and Clinical Sciences

TURP = Transurethral resection of prostate

Traditionally, distilled water was used as irrigation fluid but fell out of practice due to dilutional hyponatremia and intravascular RBC hemolysis. If monopolar probe is used, LR and NS cannot be used due to current dispersion.  NS can be used if bipolar or laser probe is used and this has lead to a lower incidence of TURP syndrome. Glycine is added to water if monopolar is used. Excessive glycine absorption leads to blindness and encephalopathy.

TURP syndrome: nausea, headache, dizziness are initial signs. Progress to dyspnea, confusion, hypertension, and bradycardia. Eventually, it progress to seizures and even cardiac arrest. Caused by circulatory overload due to absorption of irrigation fluid by prostate vasculature.

Spinal anesthesia for TURP allows for awake patient during procedure and thus can help detect earlier signs of TURP syndrome.  Many texts suggest that spinal anesthesia is protective and reduces the incidence of TURP syndrome; however, there is little evidence to demonstrate significant difference in outcomes between general and spinal anesthesia.

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2018

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