TURP: Irrigating fluid complications
Advanced, Clinical - Renal/Urine/Electrolytes, Organ-Based and Clinical Sciences
Transurethral Resection of the Prostate (TURP) typically utilizes large volumes of irrigation fluids for distension and irrigation during the procedure. Historically, these fluids were slightly hyposomolar solutions of glycine, sorbitol, or glucose. Importantly, these fluids are non-conductive (non-electrolyte containing) and are able to be used with monopolar resectoscopes. During prostate resection, exposure of the venous sinuses and damage to the prostatic capsule leads to systemic absorption of large volumes of irrigation fluids. Absorption of these hyposomolar solutions can result in pulmonary edema, congestive heart failure, and hyponatremia, which can manifest in neurologic sequelae such as seizures and coma. Specific additives can also have adverse effects: glycine can have cardiac and renal toxicities, and glucose can clearly cause hyperglycemia. Absorbed Glycine can also be metabolized in the liver to ammonia and may lead to visual impairment. High ammonia levels may result in neurologic disturbance. Other complications that can result from absorption of large volumes of irrigating fluids are hypothermia and coagulopathy. The increased use of bipolar resectoscopes has enabled the use of electrolyte-containing crystalloid solutions. Use of these solutions has reduced the incidence of TURP syndrome. However, while patients may be at reduced risk for hyponatremia: hypervolemia, pulmonary edema, and CHF are still possible complications due to absorption of large amounts of crystalloid solutions.