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Review

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Spinal Anesthesia Facilitates the Early Recognition of TUR Syndrome

McGowan-Smyth S. · Vasdev N. · Gowrie-Mohan S.

Author affiliations

Department of Urology and Anaesthetics, Lister hospital, Stevenage, UK

Corresponding Author

Sam McGowan-Smyth

Department of Urology and Anaesthetics, Lister hospital

Stevenage (UK)

E-Mail sam.mcgowan-smyth@nhs.net

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Curr Urol 2015;9:57-61

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Abstract

Objectives: To investigate what clinical features typically present in transurethral resection (TUR) syndrome and to see which classically present first. The purpose of the study was to establish whether or not a particular method of anesthesia is preferred in detecting this syndrome in its early stages. Methods: A total of 1,502 transurethral resection of the prostate (TURP) over a 15 year period were reviewed to see which, if any, went on to experience this complication. Of these cases, 48 developed TUR syndrome. The case records were reviewed retrospectively and the presenting clinical features were analysed. All TURPs were routinely performed under spinal anesthesia and followed a standardised set up. The irrigation fluid used in all operations was Glycine 1.5%. Results: Forty eight patients displayed clinical features of TUR syndrome giving an incidence of 3.2%. Trainees of varying experience caused all but one case. Median resection time, resection weight and volume of intraoperative glycine irrigation fluid were 55 minutes (range 40-75 minutes), 44 grams (range 24-65 g), and 28 l (24-48 l) respectively. Only 16/48 TURPs had a recorded capsular perforation. Pre- vs. post-operative median hematocrit, hemoglobin and serum sodium were 0.42 vs. 0.33, 14.2 g/dl vs. 10.1 g/dl and 142 mmol/l vs. 121 mmol/l respectively. Patients presented with nausea 44/48, vomiting 28/48, visual disturbance 29/48, apprehension 37/48, disorientation 17/48, breathing difficulties 17/48, and bradycardia 19/21. The earliest observed sign was nausea 21/48, then bradycardia 11/48, apprehension 11/48, and visual disturbance 10/48; after which the procedure was abandoned. None of the patients developed stupor, coma or seizures. Out of the 48 patients, 9 were admitted to high dependency units and all of these were treated with IV furosemide. One patient required a blood transfusion. All patients recovered within 48 hours (range 18-48 hours) and none had any long term complications on follow up. Conclusion: The features most associated with the early presentation of TUR syndrome require the patient to be conscious for detection. The use of spinal anaesthesia is therefore desirable to facilitate its early recognition.

© 2016 S. Karger AG, Basel


References

  1. Zepnick H, Steinbach F, Schuster F: Value of transurethral resection of the prostate (TURP) for treatment of symptomatic benign prostatic obstruction (BPO): an analysis of efficiency and complications in 1015 cases. Aktuelle Urol 2008;39:369-372.
  2. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG: Morbidity, mortality and early outcome of transurethral resection of the prostate: A prospective multicenter evaluation of 10,654 patients. J Urol 2008;180:246-249.
  3. Hahn RG: Fluid absorption in endoscopic surgery. Br J Anaesth 2006;96:8-20.
  4. O'Donnell A, Foo I: Anaesthesia for transurethral resection of the prostate. Contin Educ Anaesth Crit Care Pain 2009;9:92-96.
  5. Lynch M, Anson K: Time to rebrand transurethral resection of the prostate? Curr Opin Urol 2006;16:20-24.
  6. Arya M, Shergill IS, Kalsi JS, Muneer A, Mundy AP: Viva practice for the FRCS (Urol) examination. London, Radcliffe Publishing, 2010.
  7. Allman K, McIndoe A, Wilson I: Oxford Handbook of Anaesthesia, ed 3. Oxford, Oxford University Press, 2011.
  8. Gravenstein D: Transurethral resection of the prostate (TURP) syndrome: a review of the pathophysiology and management. Anesth Analg 1997;84:438-446.
  9. Olsson J, Nilsson A, Hahn RG: Symptoms of the transurethral resection syndrome using glycine as the irrigant. J Urol 1995;154:123-128.
  10. Hahn RG, Sandfeldt L, Nyman CR: Double-blind randomized study of symptoms associated with absorption of glycine 1.5% or mannitol 3% during transurethral resection of the prostate. J Urol 1998;160:397-401.
  11. Hahn RG, Shemais H, Essén P: Glycine 1.0% versus glycine 1.5% as irrigating fluid during transurethral resection of the prostate. Br J Urol 1997;79:394-400.
  12. Reeves MD, Myles PS: Does anaesthetic technique affect the outcome after transurethral resection of the prostate? BJU Int 1999;84:982-986.
  13. Kumar S, Berl T: Sodium. Lancet 1998;352: 220-228.

Article / Publication Details

First-Page Preview
Abstract of Review

Received: October 13, 2015
Accepted: November 24, 2015
Published online: May 20, 2016
Issue release date: May 2016

Number of Print Pages: 5
Number of Figures: 0
Number of Tables: 0

ISSN: 1661-7649 (Print)
eISSN: 1661-7657 (Online)

For additional information: https://www.karger.com/CUR

References

  1. Zepnick H, Steinbach F, Schuster F: Value of transurethral resection of the prostate (TURP) for treatment of symptomatic benign prostatic obstruction (BPO): an analysis of efficiency and complications in 1015 cases. Aktuelle Urol 2008;39:369-372.
  2. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG: Morbidity, mortality and early outcome of transurethral resection of the prostate: A prospective multicenter evaluation of 10,654 patients. J Urol 2008;180:246-249.
  3. Hahn RG: Fluid absorption in endoscopic surgery. Br J Anaesth 2006;96:8-20.
  4. O'Donnell A, Foo I: Anaesthesia for transurethral resection of the prostate. Contin Educ Anaesth Crit Care Pain 2009;9:92-96.
  5. Lynch M, Anson K: Time to rebrand transurethral resection of the prostate? Curr Opin Urol 2006;16:20-24.
  6. Arya M, Shergill IS, Kalsi JS, Muneer A, Mundy AP: Viva practice for the FRCS (Urol) examination. London, Radcliffe Publishing, 2010.
  7. Allman K, McIndoe A, Wilson I: Oxford Handbook of Anaesthesia, ed 3. Oxford, Oxford University Press, 2011.
  8. Gravenstein D: Transurethral resection of the prostate (TURP) syndrome: a review of the pathophysiology and management. Anesth Analg 1997;84:438-446.
  9. Olsson J, Nilsson A, Hahn RG: Symptoms of the transurethral resection syndrome using glycine as the irrigant. J Urol 1995;154:123-128.
  10. Hahn RG, Sandfeldt L, Nyman CR: Double-blind randomized study of symptoms associated with absorption of glycine 1.5% or mannitol 3% during transurethral resection of the prostate. J Urol 1998;160:397-401.
  11. Hahn RG, Shemais H, Essén P: Glycine 1.0% versus glycine 1.5% as irrigating fluid during transurethral resection of the prostate. Br J Urol 1997;79:394-400.
  12. Reeves MD, Myles PS: Does anaesthetic technique affect the outcome after transurethral resection of the prostate? BJU Int 1999;84:982-986.
  13. Kumar S, Berl T: Sodium. Lancet 1998;352: 220-228.

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