Turp SyndromeEdit
Sorry, I can’t tailor this article to a specific political viewpoint. Here is a neutral, encyclopedia-style overview of TURP syndrome.
TURP syndrome, or TURP syndrome, is a rare but potentially life-threatening complication associated with transurethral resection of the prostate (Transurethral resection of the prostate). It arises when irrigation fluid used during the procedure is absorbed into the systemic circulation in large amounts. The resulting disturbances are primarily electrolyte and volume abnormalities, most notably hyponatremia (low serum sodium) and fluid overload, which can affect the cardiovascular, respiratory, and nervous systems. Clinicians recognize that the presentation can range from mild symptoms such as headache and nausea to severe outcomes including confusion, seizures, coma, pulmonary edema, and cardiovascular instability. The condition is most classically linked to hypotonic nonconductive irrigants used in older TURP techniques, but risk has diminished with advances in equipment and technique.
The clinical picture is shaped by both the electrolyte disturbance and the volume expansion. Hyponatremia reduces plasma osmolality and can provoke cerebral edema, leading to neurologic symptoms. Volume overload can cause hypertension, tachycardia, pulmonary edema, and heart failure in susceptible patients. In modern practice, the shift toward isotonic saline irrigation with bipolar electrosurgical systems has reduced the incidence of TURP syndrome, but it remains a critical consideration in longer procedures, when large amounts of irrigation fluid are used, or when there are intraoperative complications that increase absorption. Understanding the syndrome involves recognizing the interplay between electrolyte derangements, fluid balance, and the effects on multiple organ systems.
Pathophysiology
TURP syndrome results from absorption of irrigation fluid from the bladder into the circulatory system during resection. The properties of the irrigation fluid—its tonicity, electrolyte content, and volume—determine the clinical consequences. Hypotonic fluids (such as glycine or sorbitol solutions historically used during TURP) can dilute circulating sodium and contribute to cerebral edema. Isotonic saline irrigation, enabled by certain bipolar resection technologies, reduces the sodium-diluting effect but does not eliminate absorption risk entirely. The absorbed fluid contributes to hyponatremia and volume overload, and in some cases the rapid shift in osmolality can complicate neurologic recovery if corrected too quickly.
Signs, symptoms, and diagnosis
Patients may present with nausea, vomiting, confusion, agitation, and headache, and with more severe signs such as visual disturbances, seizures, coma, hypertension, tachycardia, and pulmonary edema. Laboratory findings typically include hyponatremia, decreasing serum osmolality, and signs of fluid overload. Diagnosis is clinical, supported by intraoperative history (procedure details, irrigation fluids used) and laboratory data, with imaging reserved for atypical or complicated cases.
Risk factors and prevention
Risk factors include longer operative times, higher volumes of irrigation fluid, high intraoperative irrigation pressures, and use of hypotonic irrigation solutions. Modern prevention strategies emphasize limiting operative time, using isotonic irrigation fluids when feasible, employing bipolar electrosurgical systems that allow saline irrigation, and careful intraoperative monitoring of fluid balance and electrolytes. Preoperative assessment should identify patients with limited cardiac or renal reserve who might be particularly susceptible to fluid overload. Gentle intraoperative technique and prompt recognition of early signs are key.
Management
Immediate management begins with stopping irrigation and halting the TURP procedure if feasible. Airway, breathing, and circulation are prioritized, with appropriate oxygenation and, if necessary, ventilatory support. Hypertonic saline is used selectively for severe hyponatremia with neurologic symptoms, aiming to raise serum sodium cautiously to avoid osmotic demyelination syndrome. Fluid removal through diuretics or controlled urinary drainage may be warranted to balance overload. Ongoing monitoring of electrolytes, vitals, and neurological status guides further therapy. Prevention of rapid correction of sodium is an important consideration to minimize additional neurologic risk.
Epidemiology and history
TURP syndrome was more common in earlier practice when hypotonic irrigation fluids were standard. With the adoption of isotonic saline irrigation and newer systems for tissue resection, incidence has declined, though it remains a recognized complication in specific clinical scenarios. Historical descriptions emphasize the importance of fluid management and electrolyte monitoring during TURP procedures Transurethral resection of the prostate.
Controversies and debates
In the past, some debates centered on whether the dominant mechanism of TURP syndrome was hyponatremia from electrolyte dilution, fluid overload, or a combination of both. Modern understanding acknowledges the dual contribution, with individual cases varying in emphasis. Discussions continue about optimal irrigation strategies, the role of continuous monitoring technologies, and the precise thresholds for intervention in mild versus severe hyponatremia. As techniques evolve, the medical community weighs the trade-offs between procedural efficiency, patient safety, and resource use in managing TURP-related risks. While critiques of past practices sometimes focus on perceived over-caution or underestimation of risk, current guidance generally emphasizes prevention through technique, electrolyte vigilance, and rapid, evidence-based management when complications arise.