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An 81-year-old man presents for transurethral resection of the prostate (TURP). Intraoperatively, he experiences hypertension and refractory bradycardia followed by seizures and cardiac arrest. Which of the following would MOST likely have prevented this event?
A. Increased hydrostatic pressure of the irrigation fluid X
B. Use of distilled water as the irrigation fluid X
C. Shorter duration of resection ✔
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Benign prostatic hypertrophy is the most common benign neoplasm in men, and transurethral resection of the prostate (TURP) with monopolar therapy remains the standard surgical treatment. During a TURP procedure, continuous irrigation is used to distend the bladder and remove blood and prostate tissue. TURP syndrome describes a series of symptoms caused by the excessive absorption of the irrigation fluid and the resulting hyponatremia and hypoosmolar state. Early symptoms of TURP syndrome in a conscious patient include headache, dizziness, agitation, and disorientation. Progression of TURP syndrome can result in hypertension and refractory bradycardia followed by seizures and cardiac arrest. However, in a patient receiving general anesthesia, early symptoms of TURP syndrome are more difficult to detect.
The risk of TURP syndrome depends on the amount of fluid absorbed, which is affected by the hydrostatic pressure of the irrigation fluid, the number of opened venous sinuses, and the duration of the resection. Reduced hydrostatic pressure and a shorter duration of resection reduces the risk. The choice of irrigating fluid is also important. Monopolar therapy cannot be used with electrolyte-containing solutions. Distilled water, once commonly used, has fallen out of favor due to its potential to cause significant dilutional hyponatremia. Distilled water is hypotonic and can cause hemolysis and TURP syndrome when absorbed intravascularly during prolonged resections. Glycine may be used as the irrigation fluid during monopolar therapy and is only slightly hypoosmolar. However, large amounts of glycine absorption may lead to transient blindness. Lactated Ringer and normal saline cannot be used during monopolar therapy because they are ionized and disperse the current from the monopolar resectoscope. However, newer techniques involving bipolar and laser devices are compatible with electrolyte-containing solutions such as lactated Ringer and normal saline. These solutions reduce the risk of TURP syndrome and hyponatremia.
Other complications of TURP procedures include postoperative bleeding, ammonia toxicity, hypothermia, and bacteremia.
References
Date of last update: September 10, 2025
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